2021 Prenatal ultrasound diagnosis code
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A guideline list of diagnosis codes acceptable for billing specific prenatal ultrasound CPT codes for Simply Healthcare Plans, Inc., Clear Health Alliance, and the Florida Healthy Kids program; intended for providers submitting claims for Medicaid-covered prenatal ultrasound services.
No material clinical or coverage changes in this revision.
Coverage guidance and diagnosis code lists for prenatal ultrasound
Prenatal ultrasound billing guidance
Acceptable diagnosis codes for billing prenatal ultrasound CPT codes during the effective period are provided as a guideline;
Code listing for claims
This section provides the diagnosis codes to be used for prenatal ultrasound claims.
Coverage stance not specified in this segment
No explicit coverage criteria or stance provided in this excerpt — only code listings are present.
Code list guidance (partial)
This bulletin provides lists of ICD-10-CM O-series diagnosis codes for prenatal ultrasound claims submissions.
Coding list (informational)
The document presents diagnosis codes to be used when submitting prenatal ultrasound claims; no coverage rules or restrictions are stated in this excerpt.
Code list (informational)
This bulletin provides the list of diagnosis codes applicable to prenatal ultrasound claims for 2021; no explicit coverage rules or criteria are provided in this segment.
Code list-only (no coverage rules in this part)
This section does not state coverage criteria; it enumerates diagnosis codes to be used with prenatal ultrasound claims.
Codes-only listing; no coverage criteria in this part
This segment provides diagnosis codes to be used when submitting claims for prenatal ultrasound services; it does not itself specify coverage rules or medical necessity criteria in this part.
Prenatal ultrasound diagnosis code list
The document enumerates diagnosis codes applicable for prenatal ultrasound claims; no additional coverage criteria or medical necessity rules are included in these chunks.
Coding list (informational)
List of diagnosis codes associated with prenatal ultrasound claims; no explicit coverage criteria or limits are present in this excerpt.
Referenced CPT and ICD-10 diagnosis codes (samples)
| D250 | Diagnosis code listed as acceptable for prenatal ultrasound |
| D251 | Diagnosis code listed as acceptable for prenatal ultrasound |
| D252 | Diagnosis code listed as acceptable for prenatal ultrasound |
| D259 | Diagnosis code listed as acceptable for prenatal ultrasound |
| O36 | Maternal care for fetal problems and other fetal conditions (numerous subcodes listed in document) |
| O365913 | |
| O3661X2 | |
| O368120 |
| O365913 | ICD-10-CM prenatal ultrasound related diagnosis code (as listed) |
| O368120 | ICD-10-CM prenatal ultrasound related diagnosis code (as listed) |
| O41102 | ICD-10-CM prenatal ultrasound related diagnosis code (as listed) |
| O3692X0 | ICD-10-CM code listed in prenatal ultrasound diagnosis list |
| O3692X1 | ICD-10-CM code listed in prenatal ultrasound diagnosis list |
| O41102 | ICD-10-CM code listed in prenatal ultrasound diagnosis list |
| O368120 | ICD-10-CM code listed in prenatal ultrasound diagnosis list |
| O418X90 | Example prenatal ultrasound diagnosis code listed |
| O365913 | Example prenatal ultrasound diagnosis code listed |
| O41102 | Example prenatal ultrasound diagnosis code listed |
| O368135 | Listed prenatal ultrasound diagnosis code (example) |
| O3690X0 | Listed prenatal ultrasound diagnosis code (example) |
| O4100X0 | Listed prenatal ultrasound diagnosis code (example) |
| O411212 | Example obstetric diagnosis code appearing in list |
| O418X10 | Example obstetric diagnosis code appearing in list |
| O365913 | Example obstetric diagnosis code appearing in list |
| O3671X9 | |
| O368120 | |
| O41102 | |
| O418X10 | |
| O365913 |
| O418X14 | ICD-10 diagnosis code listed in prenatal ultrasound code list |
| O4190X0 | ICD-10 diagnosis code listed in prenatal ultrasound code list |
| O365913 | ICD-10 diagnosis code listed in prenatal ultrasound code list |
| O41102 | ICD-10 diagnosis code listed in prenatal ultrasound code list |
| O368935 | ICD-10-CM diagnosis code listed in bulletin |
| O3690X0 | ICD-10-CM diagnosis code listed in bulletin |
| O41102 | ICD-10-CM diagnosis code listed in bulletin |
| O365913 | ICD-10 diagnosis code included in bulletin |
| O368120 | ICD-10 diagnosis code included in bulletin |
| O3693X9 | ICD-10 diagnosis code included in bulletin |
| O411222 | Diagnosis code included in list |
| O418X10 | Diagnosis code included in list |
| O365913 | Diagnosis code included in list |
| O3680X0 | Diagnosis code included in list |
| O4192X0 | Diagnosis code included in list |
| O4100X3 | Listed prenatal ultrasound diagnosis code (example entry from list) |
| O418X10 | Listed prenatal ultrasound diagnosis code (example entry from list) |
| O41102 | Listed prenatal ultrasound diagnosis code (example entry from list) |
| O368939 | |
| O368990 | |
| O3690X0 | |
| O41102 | |
| O418X10 | |
| O4190X0 | |
| O4210 | |
| O4290 | |
| O440 |
Billing responsibilities and provider guidance
Provider billing responsibility
This list is a guideline; providers remain responsible for selecting and submitting the correct CPT code, modifier and diagnosis code combinations when billing prenatal ultrasound services.
- Guideline effective Oct 1, 2020 to Sep 30, 2021; applies to Simply, CHA and Florida Healthy Kids Medicaid programs.
Prenatal ultrasound ICD-10-CM diagnosis codes (O36-series and related)
Use the enumerated ICD-10-CM diagnosis codes (predominantly O36-series and related O‑codes) from the provider bulletin when submitting claims for prenatal ultrasound services.
- Examples of listed codes include O3662X9, O3670X0, O368120, O365913 and many additional O-series codes shown across the bulletin.
ICD-10 diagnosis code listing (informational)
This excerpt provides an informational listing of ICD-10-CM diagnosis codes for prenatal ultrasound; it does not include prior authorization, denial risk, documentation, billing modifiers, or step therapy instructions.
- The code list is presented for coding/billing reference only; refer to other policy parts for medical necessity or authorization rules.
Provider bulletin: prenatal ultrasound diagnosis codes for claims
The provider bulletin lists prenatal ultrasound ICD-10-CM diagnosis codes for billing and claims submission to Simply Healthcare Plans and related programs; providers should select the most specific applicable diagnosis code from the list when submitting claims.
- Sample entries in the bulletin include O365939, O3660X0, O3661X2 and many additional O-series codes.
Providers should code claims using listed prenatal ultrasound diagnoses
Code claims using the ICD-10-CM diagnosis codes shown in the bulletin where applicable; the list is intended to guide correct coding for prenatal ultrasound services.
- Sample codes in this segment include O3692X0, O4100X3, O41102 and a wide range of O4xx and O41x series codes.
Prenatal ultrasound ICD-10-CM code list (partial — continued)
The bulletin provides an ongoing multi-part ICD-10-CM diagnosis code list for prenatal ultrasound services; continue to reference subsequent parts of the list for additional applicable codes.
- Examples from these parts include O418X90, O368135, O3690X0 and numerous other O-series codes.
Prenatal ultrasound ICD-10 code list (additional excerpt)
This chunk is a continuation of the enumerated prenatal ultrasound ICD-10-CM diagnosis codes; include the specific codes from these lines on claims where they accurately reflect the patient’s condition.
- Sample codes shown include O411212, O418X10, O368910, O368935 and many other O-series entries.
Prenatal ultrasound diagnosis codes (additional partial list)
Use the diagnosis codes in this partial list for prenatal ultrasound billing and claim submission; the bulletin enumerates numerous O-series codes to match specific obstetric conditions.
- Codes in these excerpts include O418X14, O4190X0, O368935, O4100X3 and others.
Prenatal ultrasound diagnosis code list (billing/reference)
This segment repeats and confirms ICD-10-CM O-series diagnosis codes that are applicable for prenatal ultrasound claim submissions; select the most specific code that reflects the clinical scenario.
- Representative codes shown include O365935, O368120, O411222, O418X10 and many related O‑codes.
Prenatal ultrasound ICD-10-CM codes (continued list)
Continue to reference this enumerated ICD-10-CM diagnosis code list when preparing prenatal ultrasound claims; the bulletin includes extensive O-series codes for reporting and billing.
- Entries in these sections include O4100X3, O411035, O368939, O3690X0 and many additional codes across the O and O3.. series.
Definitions and clarifications
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