82105
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
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).
4 Active Policies
AETNA-CPB-0464 — Serum and Urine Marker Screening for Fetal Aneuploidy
AETNA-CPB-0047 — Prenatal Care Provided by Primary Care Physicians
ANTHEM-LAB.00040 — LAB.00040 Serum Biomarker Tests for Risk of Preeclampsia
ANTHEM-CG-LAB-26 — CG-LAB-26 Outpatient Alpha-Fetoprotein Testing
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.