Effective April 1, 2006, TRICARE issued a change to the Ultrasound Policy, Chapter 5, Section 2.1, Paragraph III, B. Maternity Related Ultrasound.

Professional and technical components of medically necessary fetal ultrasounds are covered outside the maternity global fee. The medically necessary indications include (but are not limited to) clinical circumstances that require obstetric ultrasounds to:
    

• Estimate gestational age
• Evaluate fetal growth
• Conduct a biophysical evaluation for fetal well-being
• Evaluate a suspected ectopic pregnancy
• Define the cause of vaginal bleeding
• Diagnose or evaluate multiple births
• Confirm cardiac activity
• Evaluate maternal pelvic masses or uterine abnormalities
• Evaluate suspected hydatidiform mole
• Evaluate fetal condition in late registrants for prenatal care

The CPT procedure code ranges affected by this change include Maternity Ultrasound: 76801-76817.

It’s important to note that determining the sex of a child is not considered medically necessary.
         

What does this mean for you?
Now TRICARE covers maternity ultrasounds outside of the normal prenatal charges, so you can bill separately for these types of ultrasounds and receive reimbursement from TRICARE. Prior to this change, TRICARE covered an ultrasound as medically necessary only within the global fee. These additions are based on the ultrasound being medically necessary, and documentation of medical necessity may be needed for reimbursement.

For more information, please contact Humana Military at
1-800-444-5445.

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Updated:  August 6, 2007