CommercialBilling CodesMedium impact
Ultrasound in Pregnancy Policy Update
Ambetter·MI · OB-GYN, Radiology·Provider Bulletin
Effective date
Aug 1, 2026
We identified it
Aug 26, 2026
Summary
Ambetter from Meridian is updating its Ultrasound in Pregnancy policy (CP.MP.38) effective August 1, 2026. The policy now allows CPT 76805 to be billed a second time within a rolling six-month period if submitted by a different TIN than the previous claim, and adds 15 specific ICD-10 diagnosis codes as payable with CPT 76811 for fetal anomaly ultrasounds.
Action Required
By July 31, 2026: Billing team must update billing system logic to recognize that CPT 76805 can now be paid a second time within a rolling six-month period when submitted by a different TIN than the initial claim. Update claim edits to allow this previously denied scenario. Additionally, configure the system to recognize all 15 listed ICD-10 codes (A93.0, O35.0XX1, O35.0XX2, O35.0XX3, O35.0XX4, O35.0XX5, O35.0XX9, O35.1XX0, O35.1XX1, O35.1XX2, O35.1XX3, O35.1XX4, O35.1XX5, O35.1XX9) as payable diagnosis codes when paired with CPT 76811. Verify that frequency limit logic for CPT 76805 tracks claims by TIN to distinguish between different providers. Communicate changes to OB/GYN providers regarding the expanded payment criteria for fetal anomaly scanning. Failure to implement these changes may result in improper claim denials for qualifying ultrasounds.