23 Miss. Code. R. 222-1.3

Current through December 10, 2024

Rule 23-222-1.3 - Maternal Fetal Ultrasound

A. For a fetal biophysical profile, the physician may bill one (1) unit for each fetus being evaluated in cases of multiple gestations.

B. For an ultrasound during hospitalization, Medicaid reimburses the physician submitting a claim for a visit and a review of an ultrasound on the same date of service for the visit only. A physician's interpretation of the results of an ultrasound will be reimbursed as a separate service when prepared with a separate distinctly identifiable signed written report using the appropriate procedure code with the appropriate modifier which indicates professional component only.

C. Medicaid does not cover routine sonography during pregnancy.

D. Medicaid covers medically necessary ultrasounds when all of the following criteria are met:

1. The ultrasound is consistent with the beneficiary's signs, symptoms, and/or condition,

2. Diagnosis cannot be made through clinical evaluation of the beneficiary's signs and symptoms, and

3. The results of the ultrasound can reasonably be expected to influence the beneficiary's treatment plan.

E. For Medicaid reimbursement for any type of obstetrical ultrasound, documentation in the beneficiary's record must justify the medical necessity. This documentation includes, but is not limited to, at least one (1) of the following:

1. Fetal measurements, as applicable to gestational age, such as crown-rump length, biparietal diameter (BPD), occipitofrontal diameter/head circumference (OFD or HC), abdominal circumference (AC), or femur length (FL),

2. Fetal position,

3. Placental location,

4. Amniotic fluid assessment or measurement,

5. Suspected or known fetal anomalies or conditions,

6. Fetal measurements relative to determination of suspected or known intrauterine growth retardation (IUGR), or

7. Presence of multiple gestations.

F. Documentation must reflect the type of obstetrical ultrasound actually performed, limited or complete.

G. The biophysical profile combines ultrasound with a non-stress test to check fetal well-being. The five (5) fetal parameters checked are as follows:

1. Reactive non-stress test,

2. Fetal breathing movement,

3. Fetal body movement,

4. Fetal muscle tone, and

5. Amniotic fluid volume.

H. Documentation must include a report on each of the five (5) parameters listed in Part 222, Chapter 1 Rule 1.3.G.

I. Providers must maintain proper and complete documentation to verify services provided.

1. The provider has full responsibility for maintaining documentation to justify the services provided.

2. Records must be documented and maintained in accordance with requirements set forth in Part 200, Chapter 1, Rule 1.3.

23 Miss. Code. R. 222-1.3

Miss. Code Ann. § 43-13-121