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.