The Temporary Assistance for Pregnant Women (TEMP) program, ME codes 58 and 59, is fee-for-service only and is limited to ambulatory prenatal care.
A pregnancy or prenatal diagnosis code is required on the claim form in one of the diagnosis fields. If the TEMP participant is provided illness care, the illness diagnosis code must appear as the primary diagnosis code. However, a pregnancy or prenatal diagnosis code must also appear on the claim form.
Inpatient hospital services are not considered “ambulatory prenatal services;” therefore, inpatient hospital claims billed for participants with only TEMP eligibility are denied.
Refer to Hospital Manual, Section 13.3.C – Presumptive Eligibility Program (TEMP) for further information on the TEMP program for hospital services.