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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 46 / 83

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(ii) Delivery outside a hospital. If delivery occurs outside a hospital, the hospital length

of stay begins at the time the mother or newborn is admitted as a hospital inpatient in connection

with childbirth. The determination of whether an admission is in connection with childbirth is a

medical decision to be made by the attending provider.

(3) Examples. The rules of paragraphs (a)(1) and (2) of this section are illustrated by the

following examples. In each example, the group health plan provides benefits for hospital lengths

of stay in connection with childbirth and is subject to the requirements of this section, as follows:

Example 1. (i) A pregnant woman covered under a group health plan goes into labor and is admitted to the hospital at 10 p.m. on June 11. She gives birth by vaginal delivery at 6 a.m. on June 12.

(ii) In this Example 1, the 48-hour period described in paragraph (a)(1)(i) of this section ends at 6 a.m. on June 14.

Example 2. (i) A woman covered under a group health plan gives birth at home by vaginal delivery. After the delivery, the woman begins bleeding excessively in connection with the childbirth and is admitted to the hospital for treatment of the excessive bleeding at 7 p.m. on October 1.

(ii) In this Example 2, the 48-hour period described in paragraph (a)(1)(i) of this section ends at 7 p.m. on October 3.

Example 3. (i) A woman covered under a group health plan gives birth by vaginal delivery at home. The child later develops pneumonia and is admitted to the hospital. The attending provider determines that the admission is not in connection with childbirth.

(ii) In this Example 3, the hospital length-of-stay requirements of this section do not apply to the child’s admission to the hospital because the admission is not in connection with childbirth.

(4) Authorization not required — (i) In general. A plan or issuer may not require that a

physician or other health care provider obtain authorization from the plan or issuer for prescribing

the hospital length of stay required under paragraph (a)(1) of this section. (See also paragraphs

(b)(2) and (c)(3) of this section for rules and examples regarding other authorization and certain

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