59426
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
14.30
Facility
$718.45
Non-Facility
$1055.47
Documentation Required
- All family practices that provide prenatal services to their patients must identify themselves to Aetna and must agree to abide by Aetna policies for this care.
- The practice will be responsible to present a fetal aneuploidy screening consent form to the member for accept/decline signature in the first trimester.
- All genetic testing will be coordinated through the Aetna Beginning Right Maternity Program (documentation of coordination/enrollment required).
- The practice will enroll the member in Aetna's Beginning Right Maternity Program (enrollment documentation).
Key Coverage Criteria
- The pregnant Aetna member must be offered the choice of prenatal care by either the practice or a participating obstetrician.
- This Clinical Policy Bulletin addresses prenatal care provided by primary care physicians.
- Aetna members may choose to remain with their qualified family physician for delivery or for prenatal care only.
- All family practices that provide prenatal services to their patients must identify themselves to Aetna and must agree to abide by Aetna policies for this care.
- When a member chooses to remain in the primary care practice for prenatal care, the following must occur: [see limitations and documentation].
- CPT codes covered if selection criteria are met: 59025 (Fetal non-stress test).
1 Active Policy
AETNA-CPB-0047 — Prenatal Care Provided by Primary Care Physicians
Related Codes
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