S0199 — Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Appropriate ICD-10 diagnosis codes to support elective (e.g., Z33.2, Z32.01) or therapeutic abortion (specific maternal or fetal condition codes) must be submitted with claims.
- Documentation of the underlying maternal health condition or fetal disease when therapeutic abortion CPT/HCPCS codes are used (e.g., clinical notes, diagnoses such as cancer, cardiac disease, fetal genetic abnormality, evidence of fetal demise, rape/incest documentation where applicable).