Ultrasound in Pregnancy (including 3D, 4D and 5D Ultrasound) - (0142)

Cigna covers up to two routine 2D obstetrical ultrasounds (CPT 76801/76805/76811/76815) and allows specialized follow‑up ultrasound (CPT 76816) for specific medical indications, but excludes fetal‑sex/keepsake scans and 3D/4D/5D ultrasounds (e.g., CPT 76376/76377/76499) as not medically necessary. Providers must document clinical indications and use the appropriate CPT/diagnosis codes (limited exams require a prior complete exam and 76816 requires documentation of the abnormal finding/complication); services without required coding or supporting clinical information will be denied.

"Up to two (2) routine two-dimensional (2D) standard or limited obstetrical ultrasound examinations (CPT codes 76801, 76805, 76811, 76815) are considered medically necessary."

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