Vaginal Delivery Medical Necessity

Download this tip

Did you know? Vaginal deliveries have the expectation of a Two-Midnight hospital stay.

“The Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA) is a federal law that affects the length of time a mother and newborn child are covered for a hospital stay in connection with
childbirth. In general, group health plans and health insurance issuers that are subject to NMHPA may NOT restrict benefits for a hospital stay in connection with childbirth to less than 48 hours
following a vaginal delivery or 96 hours following a delivery by cesarean section.”

Any Medicare patient with documentation of a vaginal delivery has the expectation of a Two-Midnight stay. Per Medicare’s Two-Midnight rule, the patient is appropriate for inpatient level of
care based on this expectation.

  • Exception to the Two-Midnight rule documentation is not necessary due to the mandate of the expectation.

Download the complete tip, Vaginal Delivery Medical Necessity.