Aetna and Fetal Ultrasounds

If you are coding/billing for a hospital, OB-GYN, or PCP who does OB care, you should be wary that Aetna very well may not pay for a fetal ultrasound, especially if you perform more than one per patient.

Aetna has very specific rules as to what types of fetal ultrasounds are necessary and also what types are purely experimental and investigational.

• Ultrasound to solely determine sex: Unnecessary
• Multiple detailed ultrasound fetal anatomic examinations: Experimental
• Routine evaluation of pregnant women who smoke or abuse cannabis: Experimental
• 3D or 4D ultrasounds: Experimental.

For your sake, and for the sake of being able to bill for your services, your obstetric patients should sign your facility’s specific Notice of Non-Coverage.

(The actual link to Aetna’s Clinical Policy Bulletin on Ultrasound for Pregnancy, with relevant CPT, HCPCS, and ICD-9 codes.)

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