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BabyCare Program Virginia

The goal of the BabyCare Program is to improve pregnancy and birth outcomes.

The BabyCare program includes two components:

• Case management for pregnant women and infants up to age two by a licensed

professional (Maternal Infant Care Coordination – MICC).

Services Offered

• Expanded prenatal services for pregnant women including patient education classes, nutritional services, homemaker services and substance abuse treatment services (SATS).

MICC is available for pregnant women and infants up to age two who are identified as high-risk and are eligible for Fee for Service (FFS) Medicaid, FAMIS, or FAMIS MOMS. Managed Care Organizations (MCOs) have their own high risk maternity and infant programs.

Who is Eligible?

Expanded prenatal services are available to any pregnant woman. MCOs have their own high risk maternity programs except for SATS which is covered only through the Deaprtment of Medical Assistance Services (DMAS).

• Pregnant women are eligible for BabyCare during pregnancy and up to the end of the month of their 60 day post-partum.

Service Requirements and Limitations for

• Infants are eligible for MICC up to age two.


  • DMAS must prior authorize MICC services prior to billing for care coordination.
  • Mileage may only be billed in conjunction with care coordination services.

Required for Preauthorization for MICC

  1. Maternity Risk Screen (DMAS-16) or Infant Risk Screen (DMAS-17) and
  2. Maternal Care Coordinator Record (DMAS-50)

Required for Closure Forms

Pregnancy Outcome Report (DMAS-53) or Infant Outcome Report (DMAS-54)

Other BabyCare Forms

Service Plan (DMAS-52) Letter of Agreement (DMAS-55) or Letter of Agreement in Spanish (DMAS-55-S) Notification of MCO Enrollment (DMAS-56)

RVSD 06162009 Page 1 of 3

Maternal and Child Health Division 804-786-6134 Fax: 804-225-3961

A physician, nurse practitioner or certified nurse midwife must initiate the referral of a pregnant woman or infant who meets at least one of the risk indicators identified on the Maternal or Infant Risk Screen (DMAS 16 or 17) and initiate a referral to a BabyCare provider. The BabyCare provider will then complete an assessment with the pregnant woman or caregiver of the infant, to see if the program is appropriate to meet the identified needs. The Risk Screen is not required for the patient education services for pregnant women.

BabyCare providers are agencies which have signed an agreement with DMAS. Please see the BabyCare Manual for specific provider requirements.

Rates Description Code Effective 7/1/09

Risk Screen* 99420 • Under age 21 -$8.43

• Above age 20 -$6.60 (Maternal screens: 5 per provider/11 months) (Infant screens: 2 per provider/11 months)

MICC Assessment* G9001 $25.00 (2 per provider / 11 month period)

Monthly MICC G9002 $4.05/day (requires prior authorization)

Home Visit Travel S0215 $0.49/mile (75 miles per day without additional documentation) (Must bill for care coordination same dates of

Claims Information

service, prior to billing mileage) Preparation for Childbirth S9442 $6.00/session Classes (6 sessions per provider per recipient)

Maternal Patient S9446 $6.00/session

Education Classes (6 sessions per provider per recipient)

Smoking Cessation S9446 $6.00/session (6 sessions per provider per recipient)

Nutritional Assessment* 97802 $22.88 / assessment (One visit)

Nutritional Follow up 97803 $20.06 / visit (Two visits) visit* Homemaker Services* S5131 $8.25/hour (Needs authorization for over 31days/124 hours)

*Preauthorization is not required when billing for risk screen or MICC assessment. *Attachment of Risk Screen to claim is required.

RVSD 06162009 Page 2 of 3

Maternal and Child Health Division 804-786-6134 Fax: 804-225-3961

DMAS Contacts For MICC Prior Authorization: Phone: 804-786-6134 Fax: 804-225-3961 Mail: BabyCare at DMAS 600 East Broad Street Suite 1300 Richmond, Virginia 23219 Other BabyCare Inquiries: Email: MICC@dmas.virginia.gov
Medicaid Eligibility/Prior Authorization requests/Claims inquiries http://virginia.fhsc.com or MediCall voice response system at 1-800-884-9730 or 1-800-772-9996. These options are available at no cost to the provider.
MCO Contacts for High Risk Maternity and Infant Case Management AMERIGROUP Taking Care of Baby and Me 1-800-964-2112 Anthem Future Moms 1-800-828-5891 CareNet Baby Matters 1-800-279-1878 Optima Partners in Pregnancy 1-866-239-0618 Virginia Premier Healthy Heartbeats Tidewater – 1-800-828-7989 -ext 2157 FAX -1-757-466-1133 Roanoke/Danville/Lynchburg 1-888-338-4579 – ext. 5784 FAX -1-800-827-7192 Richmond/Central/Western 1-800-727-7536 ext. 5710 FAX -1-804-819-5186