Effective Date: 12/01/2023
Med-QUEST memo QI-2130 released on December 29, 2021, reminded health plans that only medically necessary services are covered under a QUEST Integration plan. Elective services are not covered. Therefore, elective Cesarean sections are not a covered service under the HMSA QUEST Integration plan.
Additionally, identified in the memo was the elective births measure (PC-01-AD) that is part of the CMS Adult Core set.
Claim Coding Requirements
Use one of the following G-codes to appropriately identify when an elective Cesarean Section is performed:
| Code | Description |
|---|---|
| G9355 | Elective delivery (without medical indication) by Cesarean birth or induction of labor not performed (<39 weeks of gestation) |
| G9356 | Elective delivery (without medical indication) by Cesarean birth or induction of labor performed (<39 weeks of gestation) |
Payments
All Cesarean section claims may be subject to a post payment review.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |