Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
AmbetterExchange · Billing Codes · Provider Bulletin · MI · OB-GYN, RadiologyMedium impact

Ultrasound in Pregnancy Policy Update

Act
by Jul 31, 2026
Effective date
Aug 1, 2026
Identified
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.

Get alerts when payers change rules like this one

We check Ambetter and other payers every day and email you when a change matches your specialty and state.

Get Ambetter alertsPolicy Monitoring is free. No card required.

What to do

by Jul 31, 2026 · 5 steps
01Billing 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.
02Update claim edits to allow this previously denied scenario.
03Additionally, 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.
04Verify that frequency limit logic for CPT 76805 tracks claims by TIN to distinguish between different providers.
05Communicate changes to OB/GYN providers regarding the expanded payment criteria for fetal anomaly scanning.
If missed: Failure to implement these changes may result in improper claim denials for qualifying ultrasounds.

Codes mentioned

7680576811A93.0O35.0XX1O35.0XX2O35.0XX3O35.0XX4O35.0XX5O35.0XX9O35.1XX0O35.1XX1O35.1XX2O35.1XX3O35.1XX4O35.1XX5O35.1XX9

Original notice

Ultrasound in Pregnancy Policy Update
ambetterhealth.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Ambetter policiesMI policy changesOB-GYNRadiologyCode 76805Code 76811Code A93.0Code O35.0XX1Code O35.0XX2Code O35.0XX3Code O35.0XX4Code O35.0XX5Code O35.0XX9Code O35.1XX0Code O35.1XX1Code O35.1XX2Code O35.1XX3Code O35.1XX4Code O35.1XX5Code O35.1XX9

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account