CurrentPremera BluecrossPolicy N/A

Abortion — professional services coding and payment

Defines how Premera identifies and processes abortions submitted on professional claims for applicable Premera and LifeWise lines of business; payment depends on member eligibility, benefit limits, and applicable laws.

Policy Summary

PayerPremera Bluecross

PolicyAbortion — professional services coding and payment

Policy CodePolicy N/A

Change TypeMaterial — added chemical abortion codesbroadened coverage to all abortions

Effective DateN/A

Next Review DateApr 6, 2026

Key ActionAppend modifier G7 to the procedure code when pregnancy resulted from rape, incest, or is certified as life threatening.

SourceLink

POLICY UPDATE CHANGES

Added related chemical abortion codes (S0190, S0191) to the 'Codes and coding guidelines' section with guidance to bill with diagnosis codes Z33.2 or Z32.01.

Broadened the policy to cover ALL abortions.

~20+CPT/HCPCS abortion-related procedure codes listed

5 LOBsApplies to LOBs

04/06/26Most recent review

Requires G7G7 modifier requirement

Coverage Criteria

Coverage criteria

Coverage is conditional on member benefits, emergency medical condition determinations, and consistency with state and federal laws.

Coverage determined by member eligibility and benefit limits; final payment subject to claims adjudication edits and applicable fee schedules

Coverage is contingent on the determination of an emergency medical condition when applicable

Claims for services that are inconsistent with state or federal law will not be paid

Exceptions may be made where a provider or employer group contract dictates otherwise

If pregnancy resulted from rape or incest, or is certified by a physician as life‑threatening or endangering the mother’s life, the procedure code must include modifier G7

Policy Summary

PayerPremera Bluecross

PolicyAbortion — professional services coding and payment

Policy CodePolicy N/A

Change TypeMaterial — added chemical abortion codesbroadened coverage to all abortions

Effective DateN/A

Next Review DateApr 6, 2026

Key ActionAppend modifier G7 to the procedure code when pregnancy resulted from rape, incest, or is certified as life threatening.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Procedure and Billing Codes

Listed CPT and HCPCS abortion procedure codesmixed

59812	Treatment of incomplete abortion, any trimester, completed surgically
59820	Treatment of missed abortion, completed surgically; first trimester
59821	Treatment of missed abortion, completed surgically; second trimester
59830	Treatment of septic abortion, completed surgically
59840	Induced abortion, by dilation and curettage
59841	Induced abortion, by dilation and evacuation
59850	Induced abortion by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines
59851	Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation
59852	Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed intra-amniotic injection)
59855	Induced abortion by one or more vaginal suppositories (e.g., Prostaglandin) with/without cervical dilation (e.g., Laminaria), including hospital admission and visits, delivery of fetus and secundines

1–10 of 20

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Provider Actions and Claim Adjudication

Documentation Required

Coverage determined by eligibility, benefit limits, and legal compliance

Coverage and final payment for abortion-related professional services are determined by the member's eligibility, benefit limits, and the Plan's Medical Policy; reimbursement is subject to claims adjudication edits, provider scope of practice, and applicable fee schedules. Services that are inconsistent with state or federal law will not be paid.

Billing Rule

Append modifier G7 for rape, incest, or life‑threatening pregnancy

When an abortion is the result of rape or incest, or a pregnancy is certified by a physician as life threatening or endangering the mother's life, the provider must append modifier G7 to the procedure code on the professional claim.

Failure to follow this requirement may lead to increased auditing, monitoring, contractual penalties, or termination as described in the policy.

Definitions

professional claim (CMS-1500 or 837P)

DefinitionProfessional claim — claims submitted on CMS-1500 or 837P forms for professional services (applies to Premera lines of business listed in policy).

ScopeUsed to identify and process abortions submitted on a professional claim; reimbursement subject to member eligibility, benefit limits, and plan coding policies.

AdjudicationFinal payment is subject to claims adjudication edits and the applicable professional services fee schedule.

ComplianceClaims inconsistent with state and federal laws will not be paid; violations may result in auditing, penalties, or termination.

ApplicabilityApplies to Premera Blue Cross, Premera BCBS of Alaska, LifeWise Health Plan of Washington, LifeWise Assurance Company and Premera Blue Cross HMO lines of business.

G7 — Pregnancy resulted from rape or incest, or pregnancy certified by physician as life threatening or endangering the mother's life

DefinitionModifier G7 — appended to the procedure code when pregnancy resulted from rape or incest, or when pregnancy is certified by a physician as life threatening or endangering the mother's life.

Billing requirementWhen the exception applies, the G7 modifier must be appended to the abortion procedure code on the professional claim.

Related guidanceExceptions to policy may be made where a provider or employer group contract dictates otherwise.

ConsequencesFailure to follow policy may lead to increased auditing, contractual penalties, and/or termination of contract.