LDH Issues OB Ultrasound Policy Update

Date: 05/10/21

On behalf of the Louisiana Department of Health, Louisiana Healthcare Connections would like to share recent updates to the obstectric ultrasound policy effective June 12, 2021.

A minimum of three obstetric ultrasounds will be reimbursed per pregnancy (270 days) without the requirement of prior authorization or medical review when performed by providers other than maternal fetal medicine specialists:

• When an obstetric ultrasound is performed for an individual with multiple gestations, leading to more than one procedure code being submitted, this will only be counted as one obstetric ultrasound; and 
• Obstetric ultrasounds performed in inpatient hospital, emergency department, and labor and delivery triage settings are excluded from this count.

For maternal fetal medicine specialists, no prior authorization or medical review is required for reimbursement of obstetric ultrasounds. In addition, reimbursement for CPT codes 76811 and 76812 is restricted to maternal fetal medicine specialists.

In all cases, obstetric ultrasounds must be medically necessary to be eligible for reimbursement. 17-Alpha Hyd.