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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 47 / 83

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notice requirements.)

(ii) Example. The rule of this paragraph (a)(4) is illustrated by the following example:

Example. (i) In the case of a delivery by cesarean section, a group health plan subject to the requirements of this section automatically provides benefits for any hospital length of stay of up to 72 hours. For any longer stay, the plan requires an attending provider to complete a certificate of medical necessity. The plan then makes a determination, based on the certificate of medical necessity, whether a longer stay is medically necessary.

(ii) In this Example, the requirement that an attending provider complete a certificate of medical necessity to obtain authorization for the period between 72 hours and 96 hours following a delivery by cesarean section is prohibited by this paragraph (a)(4).

(5) Exceptions — (i) Discharge of mother. If a decision to discharge a mother earlier than

the period specified in paragraph (a)(1) of this section is made by an attending provider, in

consultation with the mother, the requirements of paragraph (a)(1) of this section do not apply for

any period after the discharge.

(ii) Discharge of newborn. If a decision to discharge a newborn child earlier than the

period specified in paragraph (a)(1) of this section is made by an attending provider, in

consultation with the mother (or the newborn’s authorized representative), the requirements of

paragraph (a)(1) of this section do not apply for any period after the discharge.

(iii) Attending provider defined. For purposes of this section, attending provider means

an individual who is licensed under applicable State law to provide maternity or pediatric care and

who is directly responsible for providing maternity or pediatric care to a mother or newborn child.

(iv) Example. The rules of this paragraph (a)(5) are illustrated by the following example:

Example. (i) A pregnant woman covered under a group health plan subject to the requirements of this section goes into labor and is admitted to a hospital. She gives birth by cesarean section. On the third day after the delivery, the attending provider for the mother consults with the mother, and the attending provider for the newborn consults with the mother regarding the newborn. The attending providers authorize the early discharge of both the mother

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