Compliance, Regulatory & Policies -
Policy, Billing, or Coverage Update -
2023
Reimbursement Policy: PO-RE-092v1 Ultrasound Diagnostic Procedures
Healthfirst will no longer provide reimbursement for CPT 76856 (Ultrasound, pelvic [non-obstetric], real time with image documentation; complete) or CPT 76857 Ultrasound, pelvic [non-obstetric], real time with image documentation; limited or follow-up) when billed with CPT 76830 (Transvaginal ultrasound) unless extenuating circumstances are present to validate the necessity of both studies.
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