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12465 Results

Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report; supervision and interpretation

Service Code
59050 (CPT) Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report; supervision and interpretation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report; interpretation only

Service Code
59051 (CPT) Fetal monitoring during labor by consulting physician (ie, non-attending physician) with written report; interpretation only
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Transabdominal amnioinfusion, including ultrasound guidance

Service Code
59070 (CPT) Transabdominal amnioinfusion, including ultrasound guidance
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Fetal umbilical cord occlusion, including ultrasound guidance

Service Code
59072 (CPT) Fetal umbilical cord occlusion, including ultrasound guidance
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Fetal fluid drainage (eg, vesicocentesis, thoracocentesis, paracentesis), including ultrasound guidance

Service Code
59074 (CPT) Fetal fluid drainage (eg, vesicocentesis, thoracocentesis, paracentesis), including ultrasound guidance
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Fetal shunt placement, including ultrasound guidance

Service Code
59076 (CPT) Fetal shunt placement, including ultrasound guidance
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Hysterotomy, abdominal (eg, for hydatidiform mole, abortion)

Service Code
59100 (CPT) Hysterotomy, abdominal (eg, for hydatidiform mole, abortion)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach

Service Code
59120 (CPT) Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy

Service Code
59121 (CPT) Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Surgical treatment of ectopic pregnancy; abdominal pregnancy

Service Code
59130 (CPT) Surgical treatment of ectopic pregnancy; abdominal pregnancy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

1E-1, Hysterectomy

Service Code
59135 (CPT) Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
No
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Hysterectomy is defined as the operation of excising the uterus either through the abdominal wall or through the vagina.

Limits

Dilation and curettage is not covered when performed in conjunction with a vaginal hysterectomy. Covered only when performed at the time of an abdominal hysterectomy.

Length of Stay

Covered once in a lifetime per individual

Exclusions

Dilation and curettage is not covered when performed in conjunction with a vaginal hysterectomy.

Diagnosis Requirements

Accepted diagnoses validating medical necessity are malignant and pre-malignant lesions of the female reproductive tract; endometriosis; adenomyosis; leiomyomas or fibroids; salpingitis and oophoritis; mild to moderate cervical dysplasia when prior conservative procedures failed; hyperplasia of the endometrium; dysfunctional uterine bleeding, severe idiopathic menorrhagia and/or metrorrhagia; inflammatory peritonitis; intractable procidentia (prolapsed uterus); perforation of the uterus by IUD; Class IV or V pap smear; prophylactic oophorectomy for positive family history of BRCA-1; traumatic injury to the uterus with irreparable damage; and complications of childbirth such as uterine rupture or intractable hemorrhage for Medicaid beneficiaries only. Health record documentation must support medical necessity and must be submitted for individuals under age 21 and for pelvic inflammatory disease, mild to moderate cervical dysplasia when prior conservative procedures failed, carcinoma in situ of unspecified organs, and uterine hemorrhage from placenta previa.

Place of Service

Inpatient hospital, Outpatient hospital.

How to Submit

N/A - No authorization is required

Resources

Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus

Service Code
59136 (CPT) Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Surgical treatment of ectopic pregnancy; cervical, with evacuation

Service Code
59140 (CPT) Surgical treatment of ectopic pregnancy; cervical, with evacuation
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or oophorectomy

Service Code
59150 (CPT) Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or oophorectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy

Service Code
59151 (CPT) Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Curettage, postpartum

Service Code
59160 (CPT) Curettage, postpartum
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

1E-2 Therapeutic and Non-therapeutic Abortions

Service Code
59200 (CPT) Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Therapeutic Abortion A therapeutic abortion is the termination of a pregnancy where fetal heart tones are present at the time of the abortive procedure. The termination of a pregnancy may be induced medically (prostaglandin suppositories, etc.) or surgically (dilation and curettage, etc.). This includes the delivery of a non-viable (incapable of living outside the uterus) but live fetus, if labor was augmented by pitocin drip, laminaria suppository, etc.

Non-Therapeutic Abortion A non-therapeutic abortion is any termination of a pregnancy where there has been no manual or surgical interruption of that pregnancy (missed, incomplete, spontaneous, etc.).

Limits

A non-therapeutic abortion is defined as termination of a pregnancy where there has been no manual or surgical interruption of the pregnancy, such as missed, incomplete, or spontaneous abortion. Medicaid covers non-therapeutic abortions when the procedure is medically necessary and provided in accordance with federal and state laws and regulations. Specific coverage for non-therapeutic abortion applies when the termination of pregnancy occurs without any manual or surgical interruption of that pregnancy, including missed, incomplete, and spontaneous abortions.

Place of Service

Inpatient, Outpatient Hospital, Office

How to Submit

N/A - No authorization is required

Resources

Episiotomy or vaginal repair, by other than attending

Service Code
59300 (CPT) Episiotomy or vaginal repair, by other than attending
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Cerclage of cervix, during pregnancy; vaginal

Service Code
59320 (CPT) Cerclage of cervix, during pregnancy; vaginal
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Cerclage of cervix, during pregnancy; abdominal

Service Code
59325 (CPT) Cerclage of cervix, during pregnancy; abdominal
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required