Pregnancy Support

Nebraska Total Care has a Provider Incentive Program to support notification of pregnancy through the Notification of Pregnancy (NOP) and Obstetric Needs Assessment Forms (ONAF) to the health plan. The early notification allows for earlier engagement during the pregnancy to assist with social determinants of health and engage the member into the health plan’s case management support. This also is an effort to reduce the recurrence of preterm births.

In 2026, this incentive has been enhanced to include an additional incentive for submission of both a NOP or ONAF and for use of prenatal or postpartum  CPT® II coding.  Note: EMR prenatal documentation incentive from 2025 no longer applies.

The incentive is limited to providers within the Nebraska Total Care network and is based on timely submission of the NOP and ONAF forms and/or CPT® II coding submission.

NOP / ONAF Forms:

• The Notification of Pregnancy NOP Form (PDF) is located on the Nebraska Total Care Provider Portal and Nebraska Total Care provider website.
• ONAF form (PDF)  is located on the Nebraska DHHS MLTC website.
• Submitted forms must be accurate and complete, i.e., member name, date of birth, member ID, full name of provider, gestation, initial OB visit date and Provider’s Tax ID Number (TIN).
• Duplicate ONAF and NOP forms will not qualify for incentive payment.
• HEDIS Guide - Maternal Health measures
• Incentives will be paid bi-annually.

CPT II Codes:

• Initial prenatal visit: CPT® II code: 0500F (initial prenatal care visit) or CPT® II Code 0501F (prenatal flow sheet documented in medical record by first prenatal visit)
• Postpartum visit (within 7-84 days post-delivery): CPT® II code: 0503F
• In addition to billing with the appropriate global maternity services, please report the initial prenatal visit with the appropriate CPT® Category II code and date of service for the initial prenatal visit and postpartum visit. Based on what works best for your billing system, this can be done on a separate claim on the date of the visit or on the same claim as the global maternity billing**, labs or diagnostic test.
• This payment is in addition to your current contract rate. CPT® II Incentive payments are made at the time of claims payment. Please add this to your requested amount in your claims total.

*Each type of Incentive will only be payable once per pregnant member per pregnancy, only payable to par providers.

**For providers who bill global OB (i.e. 59400 or 59410) or antepartum only package (i.e. 59425 or 59426), CPT® Category II codes 0500F, 0501F, 0503F will be required in addition to the global codes. Providers will only be paid once per member per pregnancy for this CPT® II  code, within a 6-month period. If Nebraska Total Care receives multiple claims with the CPT® II  code, CPT® II  incentive will not be paid on subsequent claims for same member, same pregnancy.

Program Monitoring and Payments

• Nebraska Total Care will closely monitor program compliance.
• Incentives will be paid quarterly.

State Health Resource: Maternal Health For Providers

Electric Breast Pump Billing

Nebraska Total Care wants to help our members who are breastfeeding. We will cover an electric breast pump (PDF) to new mothers in our plan. The member can get:

• One electronic breast pump per member, per delivery. For multiples (twins, triplets, etc.) only one pump will be provided.
• Breast pump kit

Prior to birth: A breast pump may be requested during pregnancy. Please bill using the UNBORN's Medicaid ID.

After date of birth: Once the baby has been delivered a breast pump may be requested under the newborn's coverage, until one year after the baby's birth. Please bill to the NEWBORN's new Medicaid ID once assigned, if eligible.

Medicaid Provider Bulletin 25-01 (PDF): Breast Pumps and Lactation Counseling