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Per Physician Manual, Section 13.57.B, routine ultrasounds are not indicated in normal pregnancies. However, MO HealthNet reimbursement is available for up to three ultrasound procedures during any one rolling year, when reasonable and necessary based on medical indication(s).
Ultrasounds provided in excess of three, during any one rolling year, must be medically necessary. All services must be adequately recorded in the patient's record and must demonstrate appropriateness of use in proper diagnosis, management and treatment of pregnancy-complicating or potentially complicating conditions.
Refer to Physician Manual, Sections 13.57.B(1) and 13.57.B(2) for an ultrasound indication checklist and non-covered ultrasound services.