CPT 76812, in plain terms, covers An ultrasound exam that provides detailed images of an additional fetus during pregnancy. CPT 76812 is referenced in 6 tracked payer policy changes from Arkansas Medicaid, Connecticut Medicaid (HUSKY Health), and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 76812 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 76812 on AAPC
Effective September 1, 2026, Arkansas Department of Human Services removed prior authorization limitations for non-stress tests (CPT 59025) and fetal ultrasounds (CPT 76801-76828). Providers can now bill these procedures without hitting the previous two-per-nine-month-period cap, but must maintain documentation supporting medical necessity for all claims, which remain subject to retrospective review and recoupment.
Connecticut Medicaid (HUSKY Health) increased reimbursement rates for obstetric surgical, radiology, and office services under OBS and FTO rate types to 120% of 2025 Medicare physician fee schedule, effective retroactively to January 1, 2026. Claims meeting the increased rates will be automatically adjusted on April 24, 2026.
Aetna considers the non-invasive fetal membranes rupture tests, including Actim PROM, AmniSure ROM, Chorioquick and the ROM Plus Fetal Membranes Rupture Test, experimental, investigational, or unproven for detecting preterm rupture of membranes and for all other indications. Aetna also considers the Biobeat Monitoring Platform, evaluation of vaginal microbiome profiles, fetal membrane imaging, functional placental MRI and amniotic fluid suPAR experimental, investigational, or unproven for their listed uses. CPT codes 84112, 74712 and 74713 are not covered for the indications listed.
Aetna's Clinical Policy Bulletin 0757 considers non-invasive fetal membranes rupture tests, including Actim PROM, AmniSure ROM, Chorioquick and the ROM Plus Fetal Membranes Rupture Test, experimental, investigational or unproven for detecting preterm rupture of membranes and all other indications. The same status applies to the Biobeat Monitoring Platform, evaluation of vaginal microbiome profiles, fetal membrane imaging, functional placental MRI for infection or inflammation in preterm PROM, and amniotic fluid suPAR for diagnosing fetal inflammatory response syndrome. The policy also lists specific CPT codes, including 84112 for cervicovaginal fluid amniotic protein evaluation, as not covered for the indications it lists.
Detailed fetal anatomic ultrasound (CPT 76811) is medically necessary for listed indications, including known or suspected fetal anatomic or genetic abnormalities, pregnancies resulting from in vitro fertilization (IVF), obesity with a pre-pregnancy body mass index of 30 kg/m2 or more, known or suspected Zika virus exposure, and a previous pregnancy with a fetus that had an omphalocele or other ultrasound detectable congenital anomaly associated with an elevated risk of recurrence. Ultrasounds done solely to determine fetal sex or to give parents a view and photograph of the fetus are not medically necessary, and more than one detailed fetal anatomic ultrasound in the first trimester or more than one in the second semester is considered not medically necessary. A limited duplex scan (CPT 93976) is medically necessary for listed obstetric indications such as vaginal bleeding in the second or third trimester, suspected placenta accreta spectrum, and suspected placental abruption, while a complete duplex scan (CPT 93975) during pregnancy is considered experimental, investigational, or unproven, and 3D and 4D fetal ultrasounds are not supported because of a lack of evidence that they alter management over standard two-dimensional ultrasound.
Aetna considers asfotase alfa (Strensiq) medically necessary for perinatal/infantile-onset and juvenile-onset hypophosphatasia (HPP) when the member has signs or symptoms of HPP, onset before 18 years of age, and a diagnosis confirmed either by a known pathogenic ALPL gene variant or by skeletal abnormalities on imaging with a below-range serum alkaline phosphatase level and an elevated TNSALP substrate level. The drug must be prescribed by or in consultation with an endocrinologist, geneticist, or physician specializing in the treatment of metabolic bone disorders, and continuation requires improvement from baseline on at least one listed measure; all other indications are considered experimental, investigational, or unproven.
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