KMAP BULLETIN: UPDATED Reminder: OB Sonograms
Date: 05/04/18
KMAP GENERAL BULLETIN 18108
- Obstetrical (OB) sonograms are not covered when performed solely to determine the fetal sex or to provide parents a view and/or photograph of the fetus. Only one routine OB sonogram per pregnancy is allowed. Medical necessity for more than one OB sonogram per pregnancy needs to be demonstrated with medical documentation available for review to support this necessity.
- A primary or secondary diagnosis must support medical necessity (MN) for an OB sonogram. Note: If applicable, this information should be submitted with the claim.
- The following OB sonogram procedures must be billed using a primary or secondary diagnosis code indicating this was an OB procedure.
76801
76802
76805
76810
76811
76812
76813
76814
76815
76816
76817
76818
76819
76820
76821
76825
76826
76827
76828
For the changes resulting from this provider bulletin, view the updated Hospital Fee-for-Service Provider Manual, Section 8200, page 8-11; and Professional Fee-for-Service Provider Manual, Section 8400, page 8-34.Note: The implementation of State policy by the KanCare managed care organizations (MCOs) may vary. The KanCare Open Claims Resolution Log on the Kansas Medical Assistance Program (KMAP) Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.