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Effective June 15, 2021: Payment Policy - Non-obstetrical and Obstetrical Transabdominal and Transvaginal Ultrasounds

Date: 03/19/21

Superior HealthPlan presents a revised payment policy to communicate the reimbursement criteria for transabdominal and transvaginal ultrasound services. As a result, the following policy has been added, and is posted on Superior’s Clinical, Payment and Pharmacy Polices webpage for review, prior to its implementation:

POLICY

EFFECTIVE DATE

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Non-obstetrical and Obstetrical Transabdominal and Transvaginal Ultrasounds* (CC.PP.061)

06/15/2021

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Ambetter from Superior HealthPlan (Health Insurance Marketplace), Allwell from Superior HealthPlan (HMO and HMO D-SNP) (Medicare)

Policy revised to add payment criteria for obstetrical transabdominal (CPT 76856) and transvaginal (CPT 76830) ultrasounds 

* REPLACES Current  Non-obstetrical Pelvic and Transvaginal Ultrasounds (CC.PP.061)

To review all payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Superior Provider Services at:

  • 1-877-391-5921 (Medicaid [STAR, STAR Health, STAR Kids, STAR+PLUS], CHIP, Allwell from Superior HealthPlan [HMO, HMO SNP])
  • 1-877-687-1196 (Ambetter from Superior HealthPlan)