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

April 2017

Payment Policy Update: Pelvic/Transabdominal and Transvaginal Ultrasounds


Effective for dates of service beginning June 15, 2017, based on rationale from the American Congress of Obstetricians and Gynecologists (ACOG), Harvard Pilgrim will no longer separately reimburse transabdominal ultrasounds (CPT codes 76801-76812) or pelvic ultrasounds (CPT codes 76856, 76857) when performed during the same session as a transvaginal ultrasound (CPT codes 76830 or 76817).

If a provider performs a pelvic or transabdominal ultrasound and determines that the resulting image is not adequately clear and that a transvaginal ultrasound is necessary, Harvard Pilgrim considers the initial pelvic or transabdominal ultrasound to be a redundant service, and only the subsequent transvaginal ultrasound will be eligible for reimbursement. For more information, please refer to the updated Obstetrical/Maternity Care, Gynecology and Radiology Payment Policies.

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