Hypertensive Disorders of Pregnancy
Customize your policy alerts
Sign up for Aetna Policy 0368 alerts
Get alerted when Policy 0368 changes without checking for updates manually.
Monitor payer policy activity
Clinical policy bulletin governing coverage and clinical stance on hypertensive disorders of pregnancy for Aetna members; describes investigational interventions and related coding guidance affecting providers managing pregnant patients with hypertension.
No material clinical or coverage changes in this revision.
Coverage Criteria
Experimental and Investigational
The following are considered experimental and investigational because effectiveness has not been established:
Exact rationale provided in policy.
Obstetrical hypertension programs are considered experimental and investigational and are excluded from coverage because their effectiveness has not been established. Specifically, these programs have not been shown to be more effective than member self-management performed in concert with supervision by an obstetrician in reducing fetal or maternal morbidity and mortality.
Links to non-Aetna websites are provided for convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, nor for products or services described on those sites.
PEPredictDx is considered investigational. The test measures three serum protein biomarkers (KDR, ENG, and RBP4) and reports an algorithm-derived pre-eclampsia risk score, but there is a lack of evidence regarding the effectiveness of this test for identifying women at high risk for pre-eclampsia.
Coding
| 0390U | Obstetrics (preeclampsia), kinase insert domain receptor (KDR), Endoglin (ENG), and retinol-binding protein 4 (RBP4), by immunoassay, serum, algorithm reported as a risk score. |
| S9211 | Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code). |
| S9212 | Home management of postpartum hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code). |
| S9213 | Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code). |
| O10.011 - O10.019 | Hypertensive heart disease and hypertension complicating pregnancy, childbirth, and the puerperium. |
| O10.911 - O10.919 | Hypertensive heart disease and hypertension complicating pregnancy, childbirth, and the puerperium. |
| O10.111 - O10.119 | Other pre-existing hypertension complicating pregnancy, childbirth, and the puerperium. |
| O10.211 - O10.219 | Other pre-existing hypertension complicating pregnancy. |
| O10.311 - O10.319 | Pre-existing hypertensive disorder with superimposed proteinuria. |
| O11.1 - O11.9 | Hypertension complicating pregnancy, childbirth, and the puerperium (combined with preeclampsia). |
| O10.411 - O10.419 | Hypertension secondary, complicating pregnancy, childbirth, and the puerperium. |
| O13.1 - O13.9 | Pre-existing hypertensive disorder with superimposed proteinuria. (Gestational (pregnancy induced) hypertension without significant proteinuria range). |
| O14.00 - O14.03 | Gestational (pregnancy induced) hypertension with significant proteinuria. |
| O14.90 - O14.95 | Gestational (pregnancy induced) hypertension with unspecified proteinuria coding range. |
Provider Actions and Billing Guidance
Codes identified as not covered
CPT, HCPCS and ICD-10 codes listed in this Clinical Policy Bulletin are identified as not covered for the indications in this CPB: CPT 0390U; HCPCS S9211, S9212, S9213; and the ICD‑10 ranges O10.011–O10.019; O10.911–O10.919; O10.111–O10.119; O10.211–O10.219; O10.311–O10.319; O11.1–O11.9; O10.411–O10.419; O13.1–O13.9; O14.00–O14.03; O14.90–O14.95; O14.10–O14.13; O15.00–O15.9; O16.1–O16.9.
- CPT 0390U — Obstetrics (preeclampsia), KDR/ENG/RBP4 serum assay, algorithm reported as a risk score.
- HCPCS S9211 — Home management of gestational hypertension, per diem.
- HCPCS S9212 — Home management of postpartum hypertension, per diem.
- HCPCS S9213 — Home management of preeclampsia, per diem.
- ICD‑10 code ranges for hypertensive disorders of pregnancy as listed above.
Prior authorization not specified
No prior authorization requirements are specified in the sections of this Clinical Policy Bulletin.
Adhere to investigational/exclusion determinations
Follow the policy guidance regarding investigational status: obstetrical hypertension programs and PEPredictDx are considered experimental/investigational and excluded from coverage.
- Obstetrical hypertension programs: not proven more effective than member self‑management with obstetrician supervision.
- PEPredictDx: considered investigational for identifying women at high risk for pre‑eclampsia.
Document conservative outpatient monitoring per ACOG
For outpatient management, document that conservative management and monitoring are based on ACOG recommendations when applicable; use home monitoring only with validated devices and patient instruction per ACOG guidance.
- Document patient instruction on home blood pressure measurement, device validation, and written instructions.
- Record monitoring of blood pressure, proteinuria, renal/hepatic function, platelets, and fetal growth surveillance as clinically indicated.
Home blood pressure monitoring requirements
Home blood pressure monitoring should use appropriately validated devices and include patient training and clear instructions as described by ACOG; document training and device used in the medical record to support outpatient management decisions.
- Use appropriately validated home blood pressure devices.
- Provide and document patient training and clear written instructions for home monitoring.
Language services — member ID card number and referenced resources
Language assistance for members is available by calling the number on the member’s ID card; Aetna additionally references other language assistance resources in the policy’s Additional Information section.
- Call the number on the member ID card to arrange language services.
- Refer to the Additional Information resources listed in the CPB for further language assistance information.
Do not bill specific not‑covered CPT/HCPCS codes
Several specific codes are called out as not covered for indications in this CPB — include CPT 0390U and HCPCS S9211–S9213 when submitting claims and avoid billing for these services for the listed indications.
External links disclaimer
Aetna is not responsible for the content, accuracy, or privacy practices of linked non‑Aetna sites; presence of a link does not imply coverage or endorsement.
- When using external links in patient communications, note that Aetna does not guarantee content or privacy practices of those sites.
Background
Obstetrical hypertension programs typically provide a remote monitoring "package" that may include home blood pressure monitoring, weight, fetal movement, and urine protein monitoring, along with administrative and care coordination elements. Despite promising findings in small pilot studies, these programs have not been proven superior to standard care consisting of patient self-management under obstetrician supervision for reducing maternal or fetal morbidity and mortality; accordingly, their effectiveness remains unestablished.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.