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Maternal Fetal Medicine Evaluation Coding

Horizon allows coding for certain ultrasound procedures for physicians specializing in maternal fetal medicine. Physicians can now bill for Ultrasound pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or Transvaginal approach; single or first gestation, or each additional gestation (76813, 76814) with Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days) or Transabdominal approach; single or first gestation or each additional gestation (76801, 76802).

This allowance of the two procedures will be subject to claims reimbursement logic and methodology, which will pay the highest relative value unit (RVU) procedure at 100 percent of allowance and the next highest RVU at 50 percent of allowance. Horizon BCBSNJ will only allow this once per pregnancy for each patient and any subsequent submission with these code combinations will only pay on the one procedure.

Performing two ultrasound procedures on the same day must be consistent with current recommendations from the Society for Maternal Fetal Medicine and may be audited for medical documentation supporting the medical necessity of the separate services.