As of 06/01/2022- UHC announced a new prenatal ultrasound policy for the year 2022. The reimbursement for this policy will be determined post-service, with pre-pay based on the following:
- The first 3 prenatal ultrasounds are going to be covered and medical necessary: CPT® codes 76801, 76802, 76805, 76810, 76811, 76812, 76815, 76816 and 76817
- 4 or more ultrasounds will be considered proven and medically necessary for high-risk pregnancies, as described in the policy, when the treating provider will make therapeutic determinations based upon the results.
This policy applies towards professional services billed on HCFA1500 form and performed in POS 11 and 22.
This policy doesn’t apply to:
- Prenatal ultrasounds rendered in an emergency room
- Outpatient observation care
- Inpatient hospital setting
Charging patients for NON-COVERED services:
Please note, you’ll need to get written consent prior to the service if you bill patients for services denied for lack of medical necessity. Patient consent will need an estimate of the charges and a statement of the reason you believe the service may not be covered. See the “Charging members for non-covered services” protocol in the UnitedHealthcare care provider administrative guide.”
Please click here to review the new obstetrical ultrasound medical policy
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