OB Ultrasound Imaging Guidelines

This policy covers obstetrical ultrasound imaging—including routine and detailed fetal anatomy scans, first‑trimester nuchal translucency, transvaginal cervical length, IUD localization, and evaluations related to infertility/ART, vaginal bleeding, abdominal pain, suspected ectopic pregnancy, miscarriage, molar pregnancy, and fetal aneuploidy/anomaly screening—for pregnant individuals and those receiving reproductive care. Major limitations/requirements include physician review for atypical presentations, a positive or otherwise confirmed pregnancy and a documented history/physical prior to imaging, specific gestational‑age windows for exams (e.g., single anatomy survey optimal at 18–22 weeks; CPT 76805 ≥16 weeks; detailed first‑trimester 12w0d–13w6d), indication‑driven high‑risk scans typically by MFM/accredited facilities, and protocol restrictions such as transvaginal cervical length only if transabdominal ≤3.6 cm and nuchal translucency only if cfDNA is not planned or performed.