MO HealthNet Provider Hot Tip of the Week

Ultrasound Exams in Pregnancy

November 24, 2014

Per Physician Manual, Section 13.57.B, routine ultrasounds are not indicated in normal pregnancies. However, MO HealthNet reimbursement is available for up to three ultrasound procedures during any one rolling year, when reasonable and necessary based on medical indication(s).

Ultrasounds provided in excess of three, during any one rolling year, must be medically necessary. All services must be adequately recorded in the patient's record and must demonstrate appropriateness of use in proper diagnosis, management and treatment of pregnancy-complicating or potentially complicating conditions.

Refer to Physician Manual, Sections 13.57.B(1) and 13.57.B(2) for an ultrasound indication checklist and non-covered ultrasound services.

2014 Hot Tips

The MO HealthNet Division provides weekly tips to providers to assist them in receiving timely reimbursement for services provided. As each new tip is posted, existing ones are archived on the same site for easy reference. Please share these weekly tips with your billing staff.