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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

April 2017

Payment Policy Update: Fetal Anatomical Ultrasound

According to the Society for Maternal-Fetal Medicine (SMFM), a fetal ultrasound with detailed anatomic examination should only be performed when there is a known or suspected fetal abnormality, fetal growth disorder, genetic abnormality, or increased risk for fetal anatomic or genetic abnormality. Effective for dates of service beginning June 15, 2017, Harvard Pilgrim will no longer reimburse detailed fetal anatomical ultrasound (CPT codes 76811 and 76812) when performed as a routine service.

In keeping with the intended use of these codes and SMFM’s guidelines, Harvard Pilgrim will cover 76811 and 76812 only in the presence — or suspected presence — of a fetal abnormality. For more information, please refer to the updated Obstetrical/Maternity Care Payment Policy.

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Network Matters Archives

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Payment Policy Update: Fetal Anatomical Ultrasound

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator