DESCRIPTION
A qualified physician (specifically, a pediatrician or a neonatologist) is physically present in the delivery room or operating room to receive an infant on delivery.
POLICY
The services of an additional physician for the neonate at a cesarean section or vaginal delivery, when requested by the attending physician, is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
MEDICAL APPROPRIATENESS
The services of an additional physician for the neonate is considered medically appropriate if ALL of the following criteria are met:
Documentation of fetal distress or reasonable anticipation of newborn distress
Documentation that the physician attending the newborn was directly involved in providing services to the newborn
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
SOURCES
BlueCross BlueShield Association, Medical Policy Reference Manual. (4:2003). Physician attendance at delivery for newborn care (10.01.04). Retrieved October 17, 2011 from BlueWeb.
ORIGINAL EFFECTIVE DATE: 2/1983
MOST RECENT REVIEW DATE: 11/10/2011
ID_BA
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.