59400
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
37.00
Facility
$2214.48
Non-Facility
$2214.48
Documentation Required
- Recommended (per ACOG guidance cited in the CPB) components of prenatal care that women considering home birth should be offered (not described as coverage documentation requirements): 'group B Strep screening and treatment, genetic screening, as well as HIV screening.'
- No specific documentation requirements are stated in this Clinical Policy Bulletin.
- Consent for Sterilization: Form HHS-687 — Consent for sterilization (explicitly listed).
- Documentation that the member is not mentally incompetent (clinical notes or assessments indicating competence).
Key Coverage Criteria
- None — Aetna considers planned deliveries at home and associated services not medically appropriate.
- Coverage of home births will be considered when mandated by law under plans subject to state mandates.
- Policy applies to abortions, hysterectomy, and sterilization as implied by the title
- Abortions — Induced abortions (section heading appears: "1. Induced Abortions")
- Applies to all Humana Healthy Horizons in Louisiana enrolled members (scope: "This policy applies to all Humana Healthy Horizons ® in Louisiana (Plan) associates who administer, review, or communicate covered physical and behavioral health benefits and services to eligible enrolled members.")
- Use of public funds to provide induced abortion services when the service and funding meet applicable state and federal laws (including the Hyde Amendment as referenced: La. R.S. 40.1061.6 and Consolidated Appropriations Act, 2014, Public Law 113-76, Division H, Title V, §506 and §507).
3 Active Policies
AMBETTER-CP.MP.136 — Home Births
AETNA-CPB-0329 — Home Births
HUMANA-ABORTION-HYSTERECTOMY-AND-STERILIZATION-LA-MEDICAID — Abortion, Hysterectomy and Sterilization - MEDICAID - LOUISIANA
Related Codes
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