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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 60 / 83

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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. attending provider

For any longer stay, the to complete a certificate

plan requires of medical

an

necessity.

The plan then makes a

certificate of medical medically necessary.

necessity,

determination, based on the whether a longer stay is

(ii)

In this Example, the requirement that an attending

provider complete authorization for

a certificate of medical necessity the period between 72 hours and 96

to obtain 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 chi (a)(1) of t consultatio representat section do

(iii) section, at under appli and who is pediatric c

(iv) E

ld earlier than the period specified in p his section is made by an attending provi n with the mother (or the newborn’s autho ive), the requirements of paragraph (a)(1 not apply for any period after the discha

Attending provider defined.

For purpose

tending provider means an individual cable State law to provide maternity

who or p

directly are to a xample.

responsible for providing matern mother or newborn child. The rules of this paragraph (a)(

aragraph der, in rized ) of this rge. s of this is licensed ediatric care ity or

5) are

60

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