Governing Rules:

• 4.12.2

  If newborn and premature care is provided by a pediatrician,

  1. HSC 03.05G may be claimed for care of a healthy newborn infant referred by anyone practicing obstetrics and in this instance no consultation benefit may be claimed;
  2. if an infant appears initially well but becomes ill after a number of days and consultation is required as well as continuing daily care, benefits may be claimed for consultation under HSC 03.08A or 03.08AZ and the appropriate number of hospital days involved;
  3. if consultation is requested during the newborn period and continuing care is not required, a consultation benefit may be claimed, but not HSC 03.05G and
  4. subject to GR 4.12.1 routine care of a premature infant may be claimed as HSC 03.07A or 03.07AZ for the initial visit and continuing daily care benefits may be claimed as HSC 03.03D.
• 4.13.3

  The benefit for care of a healthy newborn in hospital may be claimed by the same physician who claimed the benefit for the delivery.

• 4.13.4

  If newborn and premature care is provided by a physician other than a pediatrician,

  1. the benefit for care of a healthy newborn may be claimed under HSC 03.05G whether or not the case is received as a referral;
  2. if a consultation is required, a claim under HSC 03.05G may be claimed by the attending physician and a consultation benefit by the consultant;
  3. if a newborn requires transfer to a consultant, a benefit to the attending physician may be claimed on a fee for service basis, and
  4. subject to GR 4.13.5 routine care of a healthy premature newborn may be claimed as applicable visit HSCs.
• 4.14 POST PARTUM OFFICE VISITS

  Whether the baby is ill or well the first office visit of a newborn, within 14 days of the date of birth, cannot exceed the "limited" evaluation rate if the physician has received payment for care of healthy newborn in hospital (HSC 03.05G) or inpatient care. Subsequent to the initial post-partum visit, a physician may charge under whatever HSCs are appropriate for the care provided.