76816 Medical Necessity

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CPT® Code 76816 - Diagnostic Ultrasound Procedures …

https://www.aapc.com/codes/cpt-codes/76816

CPT ® 76816, Under Diagnostic Ultrasound Procedures of the Pelvis Obstetrical The Current Procedural Terminology (CPT ®) code 76816 as maintained by American …

Coverage changes for prenatal ultrasounds

https://www.uhcprovider.com/en/resource-library/news/2022/prenatal-ultrasounds-for-june.html

We’ll make coverage determinations post-service, with pre-pay based on the following: Up to 3 prenatal ultrasounds per pregnancy, for CPT ® codes 76801, 76802, …

Master the Art of Obstetrical Ultrasound Coding

https://www.aapc.com/blog/50087-master-the-art-of-obstetrical-ultrasound-coding/

Code 76816 describes an examination designed to reassess fetal size and interval growth or reevaluate one or more anatomic …

Ultrasound for Pregnancy - Medical Clinical Policy …

https://www.aetna.com/cpb/medical/data/100_199/0199.html

This policy is based in part on The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin on Ultrasonography in Pregnancy and guidelines from the …

CG-MED-42 Maternity Ultrasound in the Outpatient Setting

https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_c159215.html

76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and …

Medical Policy Obstetrical Ultrasound & Ultrasound for …

https://www.bluecrossma.org/medical-policies/sites/g/files/csphws2091/files/acquiadam-assets/007%20Obstetrical%20Ultrasound%20and%20Ultrasound%20for%20Family%20Planning%20%20prn.pdf

Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity One routine ultrasound for normal risk pregnancy during the first trimester is considered MEDICALLY …

Clinical Policy: Ultrasound in Pregnancy - Health Net

https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/UltrasoundinPregnancy.pdf

I. One standard first trimester ultrasound (76801) is allowed per pregnancy. Subsequent standard first trimester ultrasounds are considered not medically necessary as a limited …

Obstetrical Ultrasonography – Oxford Clinical Policy

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/oxford/obstetrical-ultrasonography-ohp.pdf

• CPT code 76816 will be reimbursed when reported with modifier 59 for each additional fetus. • CPT codes 76818 and 76819: Profile assessments will be reimbursed for the …

Billing and Coding: Nonobstetric Pelvic Ultrasound

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56671

76856 is a complete evaluation and must minimally include: Female: description and measurements of the uterus and adnexal structures, measurement of the …

Cigna Medical Coverage Policies – Radiology Pelvis …

https://www.evicore.com/-/media/files/evicore/provider/network-standard/cigna_pelvis_v20_final_eff073120_pub050120.pdf

Transvaginal ultrasound is the recommended modality for imaging; no alternative modality has demonstrated sufficient superiority to justify routine use, and Transvaginal …

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