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ModifiedCommunity Care Independent Practice AssociationPolicy CP.MP.38

Ultrasound in Pregnancy

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This policy establishes medical-necessity criteria, utilization limits, exclusions, documentation expectations, and supporting diagnosis codes for obstetric ultrasound services during pregnancy. It applies to providers submitting pregnancy-related ultrasound services to affiliated health plans.

Policy Summary

PayerCommunity Care Independent Practice Association

PolicyUltrasound in Pregnancy

Policy CodePolicy CP.MP.38

Change TypeModified

Effective DateN/A

Next Review DateN/A

Key ActionDocument the specific clinical indication and question for every ultrasound, and report the supporting diagnosis.

SourceLink

POLICY UPDATE CHANGES

Nuchal translucency was removed from the policy and criteria were divided into first- and second-trimester sections.

Indications for transvaginal ultrasound were added.

The policy was reformatted and ICD-9 and ICD-10 codes were added for circumstances in which a standard ultrasound would be appropriate.

ICD-9 codes were removed and follow-up ultrasound was added as an alternative in the policy and criteria sections.

The policy allowed up to six transvaginal ultrasounds per pregnancy and added ICD-10 codes indicating when more than six transvaginal ultrasounds are appropriate.

Additional ICD-10 codes were added for standard ultrasounds, including O02.0-O02.9, O03.9, O28.0-O28.9, and Z32.01.

Diagnosis-code limitations were removed for CPT 76801 and 76805, and the frequency interval for CPT 76817 was changed from six to twelve over time.

The policy added possibility of fetal growth restriction and multifetal gestation as indications for detailed ultrasound.

The 2023 revision updated the diagnosis-code list supporting medical necessity for the first detailed fetal ultrasound.

The 2023 revision removed retired O35.0XX0-O35.0XX9 and O35.1XX0-O35.1XX9 ranges and added expanded O35 fetal-abnormality code ranges.

The policy changed the total number of allowed transvaginal ultrasounds per pregnancy to 13.

The policy added transperineal ultrasound as potentially appropriate for a standard first-trimester ultrasound scan.

The policy added possibility of fetal growth restriction and multifetal gestation as indications for detailed ultrasound.

The policy removed prior-authorization language.

1/pregnancyStandard first-trimester ultrasounds

1/pregnancyStandard later-trimester ultrasounds

1/pregnancyDetailed anatomic ultrasounds

Up to 13Transvaginal ultrasounds

Not necessary3D/4D ultrasound

14 weeksFirst-trimester cutoff

Covered Ultrasound Services and Medical Necessity

Standard first-trimester ultrasound

One standard first-trimester ultrasound is allowed per pregnancy when medically indicated.

Qualifying first-trimester indication: The ultrasound addresses a qualifying clinical indication before 14 weeks 0 days of gestation, including confirmation of an intrauterine pregnancy; evaluation of suspected ectopic pregnancy, vaginal bleeding, pelvic pain, gestational age, multiple gestation, cardiac activity, maternal pelvic or adnexal masses, uterine abnormalities, suspected hydatidiform mole, or selected fetal anomalies in a high-risk patient; use as an adjunct to chorionic villus sampling, embryo transfer, or localization and removal of an intrauterine device; or fetal aneuploidy screening.Before 14 weeks 0 days

The examination may be performed transabdominally, transvaginally, or transperineally. A transvaginal examination is reported with CPT 76817.

Standard second- or third-trimester ultrasound

One standard second- or third-trimester ultrasound is allowed per pregnancy when medically indicated.

Policy Summary

PayerCommunity Care Independent Practice Association

PolicyUltrasound in Pregnancy

Policy CodePolicy CP.MP.38

Change TypeModified

Effective DateN/A

Next Review DateN/A

Key ActionDocument the specific clinical indication and question for every ultrasound, and report the supporting diagnosis.

SourceLink

On This Page

Qualifying second- or third-trimester indication:

The ultrasound addresses a qualifying clinical indication after the first trimester, including screening or evaluation of fetal anomalies or anatomy, gestational age, fetal growth, vaginal bleeding, cervical insufficiency, abdominal or pelvic pain, fetal presentation, suspected multiple gestation, pelvic mass, hydatidiform mole, ectopic pregnancy, fetal death, uterine abnormality, fetal well-being, amniotic-fluid abnormality, placental abruption, pre-labor rupture of membranes, premature labor, abnormal biochemical markers, fetal-anomaly follow-up, suspected placenta previa, prior congenital anomaly, late entry to prenatal care, or findings that increase aneuploidy risk; or use as an adjunct to amniocentesis, cervical cerclage, or external cephalic version.

After first trimester (≥14 weeks 0 days)

The examination evaluates fetal presentation and number, amniotic fluid volume, cardiac activity, placental position, fetal biometry, and fetal anatomy.

Detailed anatomic ultrasound

One detailed anatomic ultrasound is allowed per pregnancy when the clinical criteria are met.

Indication for detailed anatomic examination: There is increased or suspected risk of a fetal anomaly based on history, laboratory abnormalities, or clinical evaluation; suspicious results are present on a limited or standard ultrasound; fetal growth restriction is possible; or the pregnancy is multifetal.One CPT 76811 per pregnancy in usual circumstances

The examination must be billed with an appropriate high-risk diagnosis code from Table 4. CPT 76811 is not intended as the routine scan for all pregnancies.

Exception permitting a second detailed anatomic ultrasound: A new maternal-fetal-medicine specialist group is taking over care, a second opinion is required, or the patient has transferred to a tertiary care center in anticipation of delivery of an anomalous fetus requiring specialized neonatal care.A second CPT 76811 only when an exception applies

Further detailed anatomic examinations are not medically necessary. Use a limited or standard follow-up examination for focused fetal-size assessment or reexamination of a known or suspected abnormal organ or system when appropriate.

Transvaginal ultrasound

Transvaginal ultrasound is medically necessary when performed for a qualifying indication and within the applicable utilization limits.

Qualifying transvaginal ultrasound indication: In the first trimester, the service is performed for the same indications as a standard first-trimester ultrasound. Later in pregnancy, it is performed to assess cervical length, evaluate placental location relative to the internal cervical os in a woman with placenta previa, or evaluate an inconclusive transabdominal ultrasound.Up to 13 transvaginal ultrasounds per pregnancy

Cervical-length screening is for women with a history of preterm labor or to monitor a shortened cervix. For singleton gestations, screening after a prior preterm birth at 14 to 27 weeks starts at 14 weeks and ends at 24 weeks, every two weeks while the cervix is at least 30 mm, with a maximum of 11 examinations; after a prior preterm birth at 28 to 36 weeks, it starts at 16 weeks and ends at 24 weeks under the same interval and cervical-length condition, with a maximum of 9 examinations; without a prior preterm birth, one examination is performed between 18 and 24 weeks.

Not medically necessary conditions

The following services or circumstances are considered not medically necessary.

Explicitly excluded use or circumstance: The ultrasound is performed solely to determine fetal sex or provide photographs; for growth evaluation less than two weeks after a prior growth scan; to confirm pregnancy without another indication; as a first-trimester follow-up without pain or bleeding; or as a three-dimensional or four-dimensional ultrasound service.Growth scans must not be performed less than two weeks apart

CPT 76376 and CPT 76377 are listed as not medically necessary. Three-dimensional and four-dimensional ultrasound lack sufficient evidence of improved outcomes over two-dimensional ultrasound.

First detailed fetal ultrasound

A first detailed fetal ultrasound is supported when the pregnancy has at least one applicable diagnosis from Table 4.

Supporting diagnosis: At least one listed ICD-10-CM diagnosis is present, including maternal disease or pregnancy complication; abnormal antenatal screening, diagnostic imaging, or laboratory finding; multiple gestation; suspected fetal anomaly or genetic, infectious, or structural condition; fetal growth, movement, heart-rate, viability, or well-being concern; placental, amniotic-fluid, or membrane disorder; bleeding, preterm labor, or other listed pregnancy complication; or another diagnosis listed in Table 4.One or more applicable Table 4 diagnoses

Examples include hypertension, diabetes, connective-tissue disease, chronic kidney disease, advanced maternal age, assisted reproductive technology pregnancy, infection or exposure, suspected fetal anomaly, multiple gestation, fetal growth abnormality, cervical shortening, placental disorder, abnormal amniotic fluid, and BMI 35.0 or greater. Report the applicable ICD-10-CM diagnosis supporting the examination.

The following are not medically necessary: ultrasound performed solely to determine fetal sex or provide fetal photographs, and growth-evaluation scans performed less than two weeks apart.

More than one standard first-trimester ultrasound per pregnancy is not medically necessary. When a suspected concern requires re-examination, a limited or follow-up assessment using 76815 or 76816 should generally be sufficient.

More than one standard second- or third-trimester ultrasound per pregnancy is not medically necessary. When a suspected concern requires re-examination, a limited or follow-up assessment using 76815 or 76816 should generally be sufficient.

Further detailed anatomic ultrasounds after the permitted examination are not medically necessary because evidence is inadequate to establish the clinical utility of multiple detailed fetal anatomic examinations. A second examination may be medically necessary only when a specified exception applies, such as transfer to a new maternal-fetal-medicine group, a required second opinion, or transfer to a tertiary center for delivery of an anomalous fetus requiring specialized neonatal care.

Three-dimensional and four-dimensional ultrasounds, including 3D rendering services, are not medically necessary. The policy also excludes fetal-sex or keepsake scans, growth scans performed less than two weeks apart, pregnancy-confirmation scans without another indication, and first-trimester follow-up scans in the absence of pain or bleeding.

Procedure and Diagnosis Coding

CPT Codes Covered When Supported by Appropriate DiagnosisCPTCovered

76801	Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (<14 weeks 0 days), transabdominal approach; single or first gestation
76805	Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (≥14 weeks 0 days), transabdominal approach; single or first gestation
76811	Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation
76817	Ultrasound, pregnant uterus, real time with image documentation, transvaginal

CPT Codes Considered Not Medically NecessaryCPTNot Covered

76376	3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation
76377	3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation

ICD-10 Diagnosis Codes that Support Medical Necessity for First Detailed Fetal UltrasoundICD-10

A92.5	Zika virus disease
B06.00 through B06.9	Rubella [German measles]
B50.0 through B54	Malaria
B97.6	Parvovirus as the cause of diseases classified elsewhere
D56.0 through D56.9	Thalassemia
D57.00 through D57.819	Sickle-cell disorders
E66.01	BMI of 35 or >
O09.511 through O09.519	Supervision of elderly primigravida
M32.0 through M32.9	Systemic lupus erythematosus (SLE)
M33.00 through M33.99	Dermatopolymyositis

1–10 of 28

1/3

Table 4: ICD-10 Diagnosis Codes that Support Medical Necessity for First Detailed Fetal UltrasoundICD-10Covered

A92.5	Zika virus disease
B06.00-B06.9	Rubella [German measles]
B50.0-B54	Malaria
B97.6	Parvovirus as the cause of diseases classified elsewhere
D56.0-D56.9	Thalassemia
D57.00-D57.819	Sickle-cell disorders
E66.01	BMI of 35 or greater
O09.511-O09.519	Supervision of elderly primigravida
M32.0-M32.9	Systemic lupus erythematosus
M33.00-M33.99	Dermatopolymyositis

1–10 of 155

1/16

Ultrasound procedure codes and standard-ultrasound diagnosis codesCPT | ICD-10Covered

76801	Standard first-trimester ultrasound
76805	Standard second- or third-trimester ultrasound
76817	Transvaginal obstetric ultrasound
O02.0-O02.9	ICD-10 diagnosis range added to the standard-ultrasound code list
O03.9	ICD-10 diagnosis code added to the standard-ultrasound code list
O28.0-O28.9	ICD-10 diagnosis range added to the standard-ultrasound code list
Z32.01	ICD-10 diagnosis code added to the standard-ultrasound code list

Updated fetal-abnormality diagnosis codesICD-10Covered

O35.0XX0-O35.0XX9	Retired diagnosis-code range removed from Table 4
O35.1XX0-O35.1XX9	Retired diagnosis-code range removed from Table 4
O35.00X0-O35.00X9; O35.01X0-O35.01X9; O35.02X0-O35.02X9; O35.03X0-O35.03X9; O35.04X0-O35.04X9; O35.05X0-O35.05X9; O35.06X0-O35.06X9; O35.07X0-O35.07X9; O35.08X0-O35.08X9; O35.09X0-O35.09X9	Added diagnosis-code ranges supporting detailed fetal ultrasound
O35.10X0-O35.10X9; O35.11X0-O35.11X9; O35.12X0-O35.12X9; O35.13X0-O35.13X9; O35.14X0-O35.14X9; O35.15X0-O35.15X9; O35.19X0-O35.19X9	Added diagnosis-code ranges supporting detailed fetal ultrasound
O35.AXX0-O35.AXX9; O35.BXX0-O35.BXX9; O35.FXX9; O35.GXX0-O35.GXX9; O35.HXX0-O35.HXX9	Added diagnosis-code ranges supporting detailed fetal ultrasound

Diagnosis codes supporting medical necessity for first detailed fetal ultrasoundICD-10Covered

A92.5; D56.0-D56.9; D57.00-D57.819; M32.0-M32.9; M33.00-M33.99; M34.0-M34.9; M35.00-M35.09; M35.1; M35.5; M35.8-M35.9; M36.0; M36.8; N18.9	Diagnosis codes added to support medical necessity for first detailed fetal ultrasound
O00.01; O00.111-O00.119; O10.012-O10.019; O10.112-O10.119; O10.212-O10.219; O10.312-O10.319; O10.412-O10.419; O10.912-O10.919; O11.2-O11.3; O12.00; O12.02-O12.03; O12.10; O12.12-O12.13; O12.20; O12.22-O12.23; O13.2-O13.3; O13.5-O13.9; O14.00; O14.02-O14.03; O14.10; O14.12-O14.13; O14.20; O14.22-O14.23; O14.90; O14.92-O14.93; O15.00; O15.02-O15.03; O15.9; O16.2-O16.3; O16.9	Pregnancy-related diagnosis codes supporting medical necessity for first detailed fetal ultrasound
O22.50; O22.52-O22.53; O23.00; O23.02-O23.03; O24.414-O24.415; O26.20; O26.22-O26.23; O26.30; O26.32-O26.33; O26.40; O26.42-O26.43; O26.612-O26.619; O26.832-O26.839; O26.843-O26.849; O26.852-O26.859; O26.872-O26.879; O28.5; O28.8-O28.9	Pregnancy-related diagnosis codes supporting medical necessity for first detailed fetal ultrasound
O29.012-O29.019; O29.022-O29.029; O29.112-O29.119; O29.122-O29.129; O29.212-O29.219; O29.292-O29.299; O30.90; O30.92-O30.93; O31.30X1-O31.30X9; O31.32X0-O31.32X9; O31.33X0-O31.33X9; O31.8X20-O31.8X29; O31.8X30-O31.8X39; O31.8X90-O31.8X99	Maternal and multifetal-gestation diagnosis codes supporting medical necessity for first detailed fetal ultrasound
O32.0XX3-O32.0XX9; O32.1XX1; O32.2XX1; O32.3XX1; O32.6XX1; O32.8XX1; O32.9XX1; O34.02-O34.03; O34.30; O34.32-O34.33; O36.20X0-O36.20X9; O36.22X0-O36.22X9; O36.23X0-O36.23X9; O36.4XX0-O36.4XX9	Maternal-care and fetal-condition diagnosis codes supporting medical necessity for first detailed fetal ultrasound
O36.60X0-O36.60X9; O36.62X0-O36.62X9; O36.63X0-O36.63X9; O36.70X0-O36.70X9; O36.72X0-O36.72X9; O36.73X0-O36.73X9; O36.80X0-O36.80X9; O36.8130-O36.8139; O36.8190-O36.8199; O36.8220-O36.8229; O36.8230-O36.8239; O36.8290-O36.8299; O36.8320-O36.8329; O36.8330-O36.8339; O36.8390-O36.8399	Fetal growth and fetal-condition diagnosis codes supporting medical necessity for first detailed fetal ultrasound
O41.8X20-O41.8X29; O41.8X30-O41.8X39; O42.00; O42.012-O42.02; O42.10; O42.112-O42.119; O42.912-O42.919; O43.012-O43.019; O43.022-O43.029; O43.112-O43.119; O43.122-O43.129; O43.212-O43.219; O43.222-O43.229; O43.232-O43.239; O43.812-O43.819	Amniotic-fluid, membrane, and placental diagnosis codes supporting medical necessity for first detailed fetal ultrasound
O44.00; O44.02-O44.03; O44.10; O44.12-O44.13; O44.20; O44.22-O44.23; O44.30; O44.32-O44.33; O44.40; O44.42-O44.43; O44.50; O44.52-O44.53; O45.002-O45.009; O45.012-O45.019; O45.022-O45.029; O45.092-O45.099	Placental and antepartum-hemorrhage diagnosis codes supporting medical necessity for first detailed fetal ultrasound
O46.002-O46.009; O46.012-O46.019; O46.022-O46.029; O46.092-O46.099; O46.8X2-O46.8X9; O46.90; O46.92-O46.93; O48.0-O48.1; O60.00; O60.02-O60.03; O60.10X0-O60.10X9; O60.12X0-O60.12X9; O60.13X0-O60.13X9; O60.14X0-O60.14X9	Antepartum bleeding, post-term pregnancy, and preterm-labor diagnosis codes supporting medical necessity for first detailed fetal ultrasound
O98.012-O98.019; O98.112-O98.119; O98.919; O99.280; O99.282-O99.283; O99.330; O99.332-O99.333; O99.512-O99.519; O9A.112-O9A.119; U07.1; Z20.821; Z20.822; Z21	Maternal infection, endocrine, respiratory, COVID-19, exposure, and HIV-related diagnosis codes supporting medical necessity for first detailed fetal ultrasound

First-trimester gestational-age cutoff

First-trimester classificationBefore 14 weeks 0 days of gestation

Applicable standard procedureCPT 76801

Permitted approachesTransabdominal, transvaginal, or transperineal

After-first-trimester gestational-age cutoff

Later-pregnancy classification14 weeks 0 days or later

Applicable standard procedureCPT 76805

Standard approachTransabdominal approach for a single or first gestation

Prior preterm birth at 14 to 27 weeks

Screening windowStart at 14 weeks and end at 24 weeks

FrequencyEvery two weeks as long as the cervix is at least 30 mm

Maximum transvaginal ultrasounds11

Prior preterm birth at 28 to 36 weeks

Screening windowStart at 16 weeks and end at 24 weeks

FrequencyEvery two weeks as long as the cervix is at least 30 mm

Maximum transvaginal ultrasounds9

No prior preterm birth

Screening windowOne exam between 18 and 24 weeks

FrequencyOnce

Maximum transvaginal ultrasounds1

Transvaginal ultrasound frequency

Historical allowanceUp to 6 transvaginal ultrasounds per pregnancy

Additional servicesICD-10 diagnosis codes were added for circumstances in which more than 6 are appropriate

Current policy limitUp to 13 transvaginal ultrasounds per pregnancy

CPT 76817 frequency interval

Earlier frequency interval6 over time

Changed frequency interval12 over time

Applicable procedureCPT 76817

Total transvaginal ultrasounds per pregnancy

Total allowance13 transvaginal ultrasounds per pregnancy

ProcedureTransvaginal ultrasound of a pregnant uterus

Clinical usesCervical-length assessment, placental-location assessment in placenta previa, or evaluation after an inconclusive transabdominal ultrasound

76817 frequency over time

ProcedureCPT 76817

Documented frequency over time12

Prior documented frequency6

Documentation, Billing, and Utilization Guidance

Documentation Required

Document the Indication and Clinical Question

Document the specific indication and clinical question for every pregnancy ultrasound, including the examination timing and type. Ultrasounds should be performed only when indicated and the documentation must show what clinical question the examination is intended to answer.

Billing Rule

Use an Appropriate High-Risk Diagnosis Code

For a detailed anatomic ultrasound (CPT 76811), submit an applicable high-risk diagnosis code from Table 4. The examination is medically necessary when evaluating a suspected anomaly based on history, laboratory abnormalities, clinical evaluation, or suspicious limited or standard ultrasound findings, and for indications such as possible fetal growth restriction or multifetal gestation.

Bill CPT 76811 with an appropriate Table 4 high-risk diagnosis code.
A detailed anatomic ultrasound is generally limited to one per pregnancy unless the policy criteria for a second examination are met.

Documentation Required

Document the Medical-Necessity Diagnosis

Record the diagnosis supporting medical necessity for the ultrasound. The supporting condition may be maternal, fetal, pregnancy-related, infectious, genetic, structural, placental, or another documented clinical finding relevant to the examination.

Examples in the supporting diagnosis table include infectious diseases or exposures, genetic or hematologic conditions, maternal disease, abnormal imaging findings, and elevated BMI.
The diagnosis must correspond to the indication documented in the medical record.

Billing Rule

Review Medicare and Medicaid Coverage Rules

Before applying this policy, review the coverage requirements applicable to the member’s program. State Medicaid provisions take precedence when they conflict with this policy, and applicable Medicare NCDs, LCDs, and Coverage Articles must be reviewed for Medicare members.

For Medicaid members, consult the applicable state Medicaid manual.
For Medicare members, review applicable CMS NCDs, LCDs, and Medicare Coverage Articles.

Denial Risk

Stay Within Ultrasound Utilization Limits

Claims may be denied when ultrasound utilization limits are exceeded or when qualifying documentation is absent. Use a limited or follow-up assessment when appropriate rather than repeating a standard examination without a documented indication.

One standard first-trimester ultrasound (CPT 76801) is allowed per pregnancy.
One standard second- or third-trimester ultrasound (CPT 76805) is allowed per pregnancy.
Up to 13 transvaginal ultrasounds are allowed per pregnancy when medically necessary.
Subsequent standard first- or second/third-trimester examinations are generally not medically necessary when CPT 76815 or 76816 can adequately reassess the concern.

Denial Risk

Avoid Non-Medically Necessary Ultrasound Uses

Do not bill ultrasound services for excluded or non-medically necessary uses. Three-dimensional and four-dimensional ultrasounds are not medically necessary because evidence does not show improved outcomes over two-dimensional ultrasound; related 3D rendering services and other listed non-indicated uses are subject to denial.

CPT 76376 and 76377 are considered not medically necessary for 3D rendering.
Do not perform ultrasound solely to determine fetal sex or provide fetal photographs.
Growth scans performed less than two weeks apart are not medically necessary.
Ultrasound solely to confirm pregnancy, without another indication, is not medically necessary.
A first-trimester follow-up ultrasound without pain or bleeding is not medically necessary.

Denial Risk

Manage Repeat Detailed Anatomic Ultrasounds

A second detailed anatomic ultrasound may be medically necessary only when a new maternal-fetal medicine specialist group assumes care, a second opinion is required, or the patient is transferred to a tertiary care center in anticipation of delivery of an anomalous fetus requiring specialized neonatal care. Further detailed anatomic examinations are considered not medically necessary because evidence is inadequate regarding their clinical utility.

Document the qualifying transfer-of-care, second-opinion, or tertiary-care circumstance.
Do not repeat detailed fetal anatomic examinations without a qualifying indication and supporting documentation.

Documentation Required

Use a Supporting Diagnosis for the First Detailed Fetal Ultrasound

For the first detailed fetal ultrasound, submit a diagnosis that supports medical necessity from the applicable Table 4 ICD-10-CM code list. Ensure the code accurately represents the documented maternal, fetal, pregnancy-related, infectious, genetic, structural, placental, or abnormal-imaging indication.

Table 4 includes qualifying diagnoses such as Zika, rubella, malaria, parvovirus, thalassemia, sickle-cell disorders, systemic lupus erythematosus, systemic sclerosis, Sjögren syndrome, abnormal diagnostic imaging findings, COVID-19 or relevant exposure, HIV status, and specified BMI ranges.
Link the supporting diagnosis to the indication for the first detailed fetal ultrasound.

Clinical Background

Ultrasound is the most common fetal imaging tool and is used to assess gestational age, fetal number, viability, placental location, fetal growth, anatomy, and other obstetric findings. The policy supports using ultrasound when there is a specific clinical indication rather than as routine screening of low-risk populations; first- or mid-trimester ultrasound also provides more reliable pregnancy dating than third-trimester ultrasound.

Ultrasound Service Definitions

Standard first-trimester ultrasound

TimingPerformed before 14 weeks and 0 days of gestation

Evaluation scopePresence, size, location, and number of gestational sacs

Available approachesTransabdominal, transvaginal, or transperineal

Standard second- or third-trimester ultrasound

Fetal assessmentFetal presentation, number, cardiac activity, fetal biometry, and anatomic survey

Maternal and placental assessmentAmniotic fluid volume and placental position

Additional clinical scopeThe examination may evaluate fetal growth, fetal well-being, cervical insufficiency, bleeding, pain, multiple gestation, and other pregnancy concerns

Detailed anatomic ultrasound

When performedWhen there is increased risk of a fetal anomaly

Risk basisHistory, laboratory abnormalities, or results of a limited or standard ultrasound

Additional indicationsPossible fetal growth restriction or multifetal gestation

Transvaginal ultrasound

DefinitionUltrasound of a pregnant uterus performed transvaginally

Cervical assessmentMay evaluate cervical length, including screening for a history of preterm labor or monitoring a shortened cervix

Other pregnancy evaluationMay evaluate placental position relative to the internal cervical os or follow an inconclusive transabdominal ultrasound