UHC-CP Obstetrical Ultrasound Reimbursement Update

September 20, 2018

Starting October 1, 2018, UHC-CP is changing their Obstetrical Ultrasound Policy to further align with Medicaid guidelines. Medicaid doesn’t consider ultrasounds to be medically necessary if they’re done only to determine the fetal sex or provide parents with a photograph of the fetus. A detailed ultrasound fetal anatomic examination is also considered medically unnecessary for a routine screening of a normal pregnancy.


What’s Changing

UHC-CP willl implement these guidelines for claims processed on or after October 1, 2018:

• UHC-CP will cover the first two obstetrical ultrasounds per pregnancy.

• UHC-CP will  only cover the third and subsequent obstetrical ultrasound procedures for members identified as high risk.

• If you submit a claim for a high-risk member, that claim must include a diagnosis code from the UnitedHealthcare Community Plan Medicaid ICD-10-CM Detailed Fetal Ultrasound Diagnosis list.

• UHC-CP will  deny claims for a third or subsequent obstetrical ultrasound procedure if they don’t include one of the codes on that list.

Learn More

You can find the full policy at UHCprovider.com/micommunityplan Reimbursement Policies.

We’re Here to Help

If you have questions about this policy, please call your Provider Service Advocate.


See attached informational flyer please for additional details.