S9213, Home management of preeclampsia, includes administrative services, professional
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- No specific documentation requirements are specified in this Clinical Policy Bulletin itself.
- For ambulatory blood pressure monitoring and home blood pressure monitors, the policy refers to related policies for medical necessity and coverage: CPB 0025 - Automated Ambulatory Blood Pressure Monitoring (for medical necessity criteria for ambulatory blood pressure monitoring) and CPB 0548 - Cardiovascular Monitoring Equipment for Home Use: Pulse, Blood Pressure, Telemonitors, and Pacemaker Monitors (for coverage of blood pressure monitors for home use). Documentation requirements for those services should follow the referenced CPBs.
- Conservative management of mild preeclampsia should include clinical monitoring records as described by ACOG: blood pressure measurements, proteinuria assessment, renal and hepatic function tests, platelet counts, and serial sonography for fetal growth (as appropriate to gestational age and clinical circumstance).
Key Coverage Criteria
- Management of hypertensive disorders of pregnancy (general subject of this Clinical Policy Bulletin).
- Home blood pressure monitoring for pregnant women with hypertension: ACOG Practice Bulletin (2019) recommends that pregnant women with hypertension be instructed on measuring blood pressure monitoring at home (procedures emphasize patient training, use of appropriately validated devices, and clear instructions).
- Conservative management of mild preeclampsia for any woman not undergoing delivery, which involves monitoring the patient's blood pressure, proteinuria, renal and hepatic function, platelet counts, and serial sonography for fetal growth; inpatient or outpatient management may be appropriate.
- I. Home health services are consideredmedically necessarywhenallof the followingcriteriaA through Dare met:
- The individual is confined to the home:The individual’s overall physical/medical condition poses a serious and significant impediment to receiving intermittent or occasional, skilled, medically necessary services outside the home setting. In general, the condition of these individuals should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort;andIf the individual does in fact leave the home, the absences from t [...]
- The individual’s overall physical/medical condition poses a serious and significant impediment to receiving intermittent or occasional, skilled, medically necessary services outside the home setting. In general, the condition of these individuals should be such that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort;and
3 Active Policies
ANTHEM-CG-MED-23, CG-MED-23 Home Health
AETNA-CPB-0368, Hypertensive Disorders of Pregnancy
AMBETTER-CP.MP.91, Obstetrical Home Care Programs
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.