O16.9 — Unspecified maternal hypertension, unspecified trimester
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Clear clinical indication and the specific diagnostic question for the ultrasound
- Documentation of ultrasound findings relevant to the indication (e.g., gestational age, fetal number, viability, placental location)
- Clinical documentation of history, laboratory abnormalities, or clinical examination supporting suspected anomaly.
- Documentation of suspicious findings from a limited or standard ultrasound when 76811 is performed for follow-up.
Key Coverage Criteria
- Outpatient urine culture testing for bacteria is consideredmedically necessaryto evaluate any of the following situations:
- Clinical signs or symptoms suggesting urinary tract infection (UTI);or
- Abnormal urinalysis suggesting UTI;or
- Asymptomatic bacteriuria in pregnant persons;or
- Bacteriuria in individuals prior to undergoing an endoscopic urologic procedure;or
- Suspected interstitial cystitis or bladder pain syndrome.
8 Active Policies
AMBETTER-CP.MP.38 — Ultrasound in Pregnancy
ANTHEM-RAD.00038 — RAD.00038 Use of 3-D, 4-D or 5-D Ultrasound in Maternity Care
ANTHEM-CG-LAB-24 — CG-LAB-24 Outpatient Urine Culture
ANTHEM-CG-LAB-20 — CG-LAB-20 Thyroid Testing
ANTHEM-CG-LAB-27 — CG-LAB-27 Human Chorionic Gonadotropin Testing
Related Codes
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