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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyHealthy Blue Louisiana Abortion Coverage | OpenPay…
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    CurrentHealthy Blue LouisianaPolicy G-06057

    Abortion (Termination of Pregnancy)

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    This policy governs reimbursement for induced abortions and distinguishes them from incomplete, missed, or septic abortions. It applies to providers submitting claims to Healthy Blue Louisiana, subject to applicable benefit, provider, state, federal, CMS, and contractual requirements.

    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyAbortion (Termination of Pregnancy)
    Policy CodePolicy G-06057
    Change TypeNo material change
    Effective DateJun 8, 2026
    Last ReviewJun 8, 2026
    Next Review DateNot specified
    Key ActionAppend modifier G7 to the appropriate procedure code when requesting reimbursement for an induced abortion procedure.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    AllowedInduced abortions may be reimbursed when policy criteria and applicable requirements are met
    G7Required modifier for induced abortion procedure claims
    No form submissionInformed consent forms are not required to be submitted with claims
    Medical necessityIncomplete, missed, and septic abortions are allowed under medical necessity criteria without informed consent
    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyAbortion (Termination of Pregnancy)
    Policy CodePolicy G-06057
    Change TypeNo material change
    Effective DateJun 8, 2026
    Last ReviewJun 8, 2026
    Next Review DateNot specified
    Key ActionAppend modifier G7 to the appropriate procedure code when requesting reimbursement for an induced abortion procedure.
    SourceLink
    On This Page
    Coverage CriteriaCoding RequirementsProvider and Claim Submission ActionsAbortion and Pregnancy-Related 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.

    No changes
    Most recent policy history entry reports no changes

    Coverage Criteria

    Induced Abortion Reimbursement Criteria

    Reimbursement for induced abortion is allowed when all applicable coverage, consent, certification, and billing requirements below are met.

    ALL of the following

    • ONE of the following provider certifications

      • The pregnancy is the result of rape or incest.
      • The woman has a physical disorder, injury, or illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that a physician certifies would place her in danger of death unless an abortion is performed.
    • Written, voluntary, and informed consent has been obtained from the woman upon whom the abortion is to be performed.

      The health plan does not require informed-consent forms to be submitted with claims.

    • The provider, state, federal, or CMS contracts and/or requirements applicable to the service do not indicate otherwise.
    • The appropriate procedure code includes modifier G7 when reimbursement is requested for an induced abortion procedure.

      Append modifier G7 to the appropriate procedure code.

    Non-Induced Abortion Treatment

    Treatment of incomplete, missed, or septic abortions is distinct from induced or elective abortion treatment and is allowed when medically necessary.

    ALL of the following

    • The service is for treatment of an incomplete, missed, or septic abortion.
    • The treatment meets applicable medical-necessity criteria.
    • The service is not being treated as an induced or elective abortion.

    Coding Requirements

    Induced abortion modifierModifierCovered
    G7Modifier indicating induced abortion; append to the appropriate procedure code

    Provider and Claim Submission Actions

    Documentation Required

    Obtain informed consent

    Obtain written, voluntary, and informed consent from the woman upon whom the induced abortion is to be performed. The health plan does not require informed consent forms to be submitted with claims.

    Documentation Required

    Certify the qualifying circumstance

    The provider performing the induced abortion must certify that the pregnancy resulted from rape or incest, or that the woman has a physical disorder, injury, or illness—including a life-endangering physical condition caused by or arising from the pregnancy—that would place her in danger of death unless an abortion is performed.

    Abortion and Pregnancy-Related Definitions

    Definition
    Abortion, Induced/ElectiveOne resulting from measures taken to intentionally end a pregnancy, using medications (medical abortion) or instrumentation (surgery).
    Definition
    Abortion, IncompletePart of the product of conception has been retained in the uterus.
    Definition
    Abortion, MissedA dead, nonviable fetus and other products of conception are retained in the uterus for two or more months.
    Definition
    Billing Rule

    Apply modifier G7

    Append modifier G7 to the appropriate procedure code when requesting reimbursement for an induced abortion procedure.

    Denial Risk

    Apply medical necessity to non-induced abortion treatment

    Do not require informed consent for treatment of incomplete, missed, or septic abortions. These services are not considered induced or elective abortions and are allowed under applicable medical necessity criteria.

    Abortion, SepticThere is an infection of the product of conception and the endometrial lining of the uterus, usually resulting from attempted interference during early pregnancy.
    Definition
    Abortion, Spontaneous/MiscarriageOccurs when a natural cause ends a pregnancy prior to 20 weeks.
    Definition
    Abortion, ThreatenedThe appearance of signs and symptoms of possible loss of embryo.
    Definition
    StillbornOccurs when a natural cause ends a pregnancy after 20 weeks.
    Definition
    Termination of PregnancySynonym for abortion.