CPT 76818, in plain terms, covers A detailed ultrasound examination of a fetus that also checks the baby's heart rate patterns to assess overall health and well-being. CPT 76818 is referenced in 4 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 76818 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 76818 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 in-office and in-hospital antepartum fetal surveillance with non-stress tests, contraction stress tests, biophysical profiles, modified biophysical profiles, and umbilical artery and middle cerebral artery Doppler velocimetry medically necessary when the criteria in this policy are met. For most pregnancies at increased risk of stillbirth due to utero-placental insufficiency, testing is considered appropriate beginning at 32 to 34 weeks of gestation, and testing is medically necessary beginning at 26 weeks for pregnancies with multiple or particularly worrisome high-risk conditions. Repeat testing is medically necessary until delivery while the condition that prompted testing persists, and remote non-stress testing, uterine artery Doppler for risk assessment or screening, and all other indications not listed as medically necessary are considered experimental, investigational or unproven.
Aetna reviewed its Clinical Policy Bulletin 0047 on prenatal care provided by primary care physicians on October 6, 2026, but the text provided does not say what changed. The policy still sets the conditions under which a family physician can provide only prenatal care to an Aetna member, including coordination with a participating obstetrician, Healthy Chapters enrollment and specific referral timing.
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