RAD.00038 Use of 3-D, 4-D or 5-D Ultrasound in Maternity Care

This policy addresses the use of 3-D, 4-D, or 5-D fetal ultrasound in maternity care. Anthem deems these modalities investigational/experimental and not medically necessary in all cases, so they are not covered. No exceptions or covered indications are provided; this applies to all obstetric uses (e.g., screening or diagnostic), with relevant codes including 76375, 76376, 76377, and 76499.

"The use of 3-D, 4-D or 5-D fetal ultrasound is consideredinvestigational and not medically necessaryin all cases."

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