In certain circumstances, medically necessary obstetrical ultrasound services are eligible for reimbursement by the Company to participating providers or hospitals at a non-capitated site.
Specialists
The circumstances for which a Rule Out Intrauterine Pathology obstetrical ultrasound is eligible for reimbursement to a participating Obstetrics-Gynecology or Reproductive Endocrinology specialist (this includes certified registered nurse practitioners [CRNPS] and Physician Assistants [PAs] practicing within these specialty groups), are outlined below.
| Procedure Code | Modifier |
76831
|
|
| 76831 | 26 |
The circumstances for which a Screening for Fetal Abnormalities obstetrical ultrasound is eligible for reimbursement to a participating maternal fetal medicine specialist (this includes CRNPS and PAs practicing within these specialty groups), are outlined below.
| Procedure Code | Modifier |
| 76805 | |
| 76810 | |
| 76813 | |
| 76814 | |
| 76825 | |
| 76826 | |
| 76827 | |
| 76828 | |
| Procedure Code | Modifier |
| 76805 | 26 |
| 76810 | 26 |
| 76813 | 26 |
| 76814 | 26 |
| 76825 | 26 |
| 76826 | 26 |
| 76827 | 26 |
| 76828 | 26 |
Outpatient Hospitals
The circumstances for which a Screening for Fetal Abnormalities obstetrical ultrasound is eligible for reimbursement to the Outpatient Hospital are outlined below.
| Procedure Code | Modifier |
| 76805 | |
| 76810 | |
| 76813 | |
| 76814 | |
| 76825 | |
| 76826 | |
| 76827 | |
76828
|
|
