Skip to Main Content

Effective January 1, 2026: New Payment Policy: Newborn Inpatient Stays

Date: 10/02/25

Ambetter from Superior HealthPlan presents a new payment policy to communicate the health plan’s billing and reimbursement requirements for newborn inpatient stays. As a result, the following policy has been created, and is posted on Superior’s Clinical, Payment and Pharmacy Policies webpage for review, prior to its implementation:

Policy

Effective Date

Applicable Products

New Policy Overview or Updated Policy Revisions

Newborn Inpatient Stays

(TX.CC.PP.075)

January 1, 2026

Ambetter from Superior HealthPlan

For inpatient newborn stays, assignment of a NICU-level DRG is dependent upon the exclusive billing of NICU revenue codes. When a claim reflects only non-NICU revenue codes (170/171 normal newborn stay), it will be re-classified and reimbursement will be adjusted to MS-DRG 795 in accordance with health plan policy requirements. 

When a claim includes both NICU and non-NICU revenue codes billed on the same claim, the claim will be excluded from the application of this reimbursement policy.

To review all clinical payment or payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Ambetter Provider Services at 1-877-687-1196.