CPT 76815, in plain terms, covers A quick ultrasound scan focusing on a specific part of a pregnancy rather than a complete exam. CPT 76815 is referenced in 6 tracked payer policy changes from Arkansas Medicaid, Connecticut Medicaid (HUSKY Health), and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 76815 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 76815 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.
Effective July 1, 2025, Maryland Medicaid now reimburses Certified Nurse Practitioners (CRNPs) for interpretation of specific radiological and imaging services. Billing teams must update systems to recognize CRNPs as eligible providers for 13 allowable CPT codes across chest X-rays, abdominal X-rays, obstetric ultrasounds, and radiotherapy planning. This applies to both fee-for-service and HealthChoice managed care organizations in Maryland.
Maryland Medicaid now allows certified nurse practitioners to interpret and bill for specific radiological and imaging services including chest X-rays, abdominal X-rays, obstetric ultrasounds, and other imaging studies. This expands billing opportunities for practices with CRNPs providing these interpretation services.
Aetna considers the fetal fibronectin (fFN) immunoassay medically necessary to evaluate pregnant women with symptoms of preterm labor who are considered high-risk for preterm delivery when amniotic membranes are intact, cervical dilation is less than 3 cm, sampling occurs no earlier than 24 weeks 0 days and no later than 34 weeks 6 days of gestation, and results will be available quickly enough to influence real-time decisions for suspected preterm labor. A repeat fFN immunoassay is medically necessary when the member meets all of the same criteria and remains symptomatic 2 or more weeks after a previous negative fFN immunoassay. Fetal fibronectin testing for routine screening of the general obstetric population, for asymptomatic high-risk women, for identifying optimal cerclage candidates, and following cervical cerclage insertion is experimental, investigational or unproven, as are the biomarker, inflammatory marker, proteomic, metabolomic and salivary hormone tests named for preterm birth prediction.
New Jersey Medicaid has updated specific HCPCS codes and fee allowances for abortion-related procedures billed on a fee-for-service basis. The policy clarifies billing procedures for ultrasounds, surgical pathology, RhoGam injections, and other services related to elective abortions for Medicaid and NJ KidCare beneficiaries.
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