UnitedHealthcare is rolling out a new obstetrical ultrasound policy for commercial members starting June 1, the payer said March 1.
Under the policy, UnitedHealthcare will consider up to three prenatal ultrasounds per pregnancy proven and medically necessary. The CPT codes accepted under the policy are 76801, 76802, 76805, 76810, 76811, 76812, 76815, 76816 and 76817.
Additionally, four or more ultrasounds will be considered proven and medically necessary for high-risk pregnancies only when the provider needs therapeutic determinations based upon the results.
UnitedHealthcare said it will consider several prenatal ultrasounds unproven and not medically necessary:
- 3D prenatal ultrasounds
- More than one detailed fetal anatomic ultrasound examination per pregnancy
- The use of prenatal or obstetrical ultrasounds for the purpose of determining the sex of the fetus
UnitedHealthcare said the policy doesn't cover ultrasounds rendered in an emergency room, during outpatient observation care or in inpatient hospital settings.
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