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ICD-10-CM O16.3, Unspecified maternal hypertension, third trimester | No Prior Auth

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`O16.3`, Unspecified maternal hypertension, third trimester

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Suspected fetal death;
Assess amniotic fluid volume in post-term gestation.
Evaluate a pelvic mass that has been detected clinically.
Maternity ultrasound is consideredmedically necessaryforanyof the following:
Routine anatomy screen and dating:One ultrasound of a pregnant uterus per member, per routine course of care;Estimate gestational age for individuals with uncertain clinical dates.
One ultrasound of a pregnant uterus per member, per routine course of care;

1 Active Policy

ANTHEM-CG-RAD-26, Maternity Ultrasound in the Outpatient Setting

Related Codes

76802(1 policies)76805(1 policies)76810(1 policies)76811(1 policies)76812(1 policies)76815(1 policies)76816(1 policies)76801(1 policies)

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