CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Medical Coverage Policy Home Uterine Activity Monitoring (HUAM)

Defines coverage position for home uterine activity monitoring devices and associated nursing contact for detection of preterm labor in pregnant women, including coding guidance and background evidence. Applies to commercial products and Medicare Advantage members of Blue Cross Blue Shield - Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMedical Coverage Policy Home Uterine Activity Monitoring (HUAM)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2015

Next Review Date

Key ActionRefer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage determinations as benefits may vary between groups/contracts.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes — policy maintained as not covered/not medically necessary.

1Primary not-covered device category

2015-10-01Effective date

2023-02-16Last policy update

Coverage Summary

Coverage stance: not covered / not medically necessary. Home uterine activity monitoring (HUAM), with or without nursing contact and including use with tocolytic therapy, is not covered because evidence is insufficient to demonstrate improved health outcomes.

Key policy facts

Effective date2015-10-01

Last review2023-02-16

Policy statusCURRENT (not covered / not medically necessary)

SubjectHome Uterine Activity Monitoring (HUAM)

Scope summaryDefines coverage position for HUAM devices and associated nursing contact for detection of preterm labor in pregnant women; applies to commercial products and Medicare Advantage members of BCBSRI.

Typical uterine contraction thresholdUsually 4 to 6 contractions per hour

Intended gestational age (FDA, informational)>= 24 weeks' gestation

Medical Necessity / Policy Determinations

Policy Statement / Coverage Determination

Home uterine activity monitoring is subject to the following coverage determination:

Home uterine activity monitoring, with or without nursing contact, is not covered.
Home uterine activity monitoring is not covered including use with tocolytic therapy.
Despite numerous scientific studies, evidence is insufficient to determine effects on health outcomes.

Commercial Products Position

Commercial product determination:

Home uterine activity monitoring, with or without nursing contact, is considered not medically necessary.
Includes use with tocolytic therapy.
Despite numerous scientific studies, evidence is insufficient to determine effects on health outcomes.

Regulatory / Intended Use (informational)

FDA indicated intended use (informational only):

Device intended for use in women at least 24 weeks' gestation with a previous preterm delivery to aid in detection of preterm labor.>= 24 weeks' gestation (intended-use informational)

CPT / HCPCS Coding

Not covered / Not medically necessary codesHCPCSNot Covered

S9001

Home uterine monitor with or without associated nursing services

Related covered procedural code (may be billed separately if applicable)CPT

99500

Home visit for prenatal monitoring and assessment to include fetal heart non-stress test, uterine monitoring, and gestational diabetes monitoring

Provider Actions / Billing Impact

Documentation Required

Reference benefit booklet / subscriber agreement

Providers must refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage determinations as benefits may vary between groups/contracts.

Denial Risk

Claims for HUAM (S9001) are not covered

Claims reporting HCPCS code S9001 (home uterine monitor with or without associated nursing services) are considered not medically necessary and are not covered for Medicare Advantage and commercial products; expect claim denial.

S9001

Background & Evidence

HUAM consists of an external guard-ring tocodynamometer belt, a data recorder, and a data transmitter. The device is worn by the patient to collect uterine activity data and is intended to provide early detection of preterm labor in women at high risk.

Patients are typically instructed to use the monitor daily for two 1-hour periods and transmit recordings (for example by telephone modem) to a remote base station where nurses review tracings, maintain daily telephone contact, assess symptoms (such as back pain, increased vaginal discharge, cramps, pelvic pressure), and advise patients. The usual threshold used to signal possible onset of preterm labor is typically 4 to 6 contractions per hour, and the FDA–stated intended use (informational) is for women at >= 24 weeks' gestation with a prior preterm delivery.

Evidence

Unsupported block type: paragraph

Definitions & Regulatory Notes

Unsupported block type: definition