OB Ultrasound Imaging Guidelines

This eviCore guideline covers medically necessary obstetrical ultrasounds, fetal echocardiography, and fetal MRI with indication‑ and gestational age–specific CPT coding, timing, and frequency recommendations (dating, viability, anatomy, growth, bleeding, ectopic, high‑risk surveillance), and expressly excludes non‑medical/keepsake or sex‑only scans and routine use of non‑obstetrical pelvic codes in pregnancy. Key requirements include a positive pregnancy test or clinical evidence of pregnancy, documentation of EDD/gestational age/prior ultrasound and relevant labs/clinical indications to justify the study and any repeat imaging (many codes limited to once per pregnancy unless change of caregiver or new indication), plus provider certification for nuchal translucency and adherence to specified timing/frequency constraints.

"Positive pregnancy test or otherwise confirmed pregnancy (required before use of obstetrical CPT codes)."