Ultrasound

HMSA covers ultrasound when medically indicated. Ultrasound for the sole purpose of gender determination is not covered by any HMSA plan.

Ultrasound may be billed separately from the global maternity fee for the following indications developed by the American College of Obstetricians and Gynecologists (ACOG) and adopted by HMSA:

• Estimation of gestational age for patients with uncertain clinical dates, or verification of dates for patients who are to undergo scheduled elective repeat cesarean delivery, indicated induction of labor, or other elective termination of pregnancy
• Evaluation of fetal growth
• Vaginal bleeding of undetermined etiology in pregnancy
• Determination of fetal presentation
• Suspected multiple gestation
• Adjunct to amniocentesis
• Significant uterine size/clinical dates discrepancy
• Pelvic mass
• Suspected hydatidiform mole
• Adjunct to cervical cerclage placement
• Suspected ectopic pregnancy
• Adjunct to special procedures
• Suspected fetal death
• Suspected uterine abnormality
• Suspected uterine abnormality
• Intrauterine contraceptive device localization
• Biophysical evaluation for fetal well-being
• Observation of intrapartum events
• Suspected polyhydramnios or oligohydramnios
• Suspected abruptio placentae
• Adjunct to external version from breech to vertex presentation
• Estimation of fetal weight and/or presentation in premature rupture of membranes and/or premature labor
• Abnormal serum alpha-fetoprotein value
• Follow-up observation of identified fetal anomaly
• Follow-up evaluation of placental location for identified "placenta previa"
• History of previous congenital anomaly
• Serial evaluation of fetal growth in multiple gestation
• Evaluation of fetal condition in late registrants for prenatal care

Note: Please do not submit separate claims for ultrasound performed as an adjunct to amniocentesis, cerclage placement, amnioscopy/fetoscopy or external version. Ultrasound is considered an integral part of these procedures.

Exceptions

There may be other conditions not appearing on the list of approved indications for which ultrasound may be appropriate. If you believe ultrasound to be medically appropriate in a specific, clinical situation, please submit information relating to your rationale for ordering or performing the service along with your claim. Such claims will be reviewed on an individual basis.

Revision History