MedicaidCoverageMedium impact
Ultrasound Exams in Pregnancy
Missouri Medicaid (MO HealthNet)·MO · OB-GYN, Family Medicine, Diagnostic Imaging·Provider Notice
Effective date
Nov 24, 2014
We identified it
Jun 20, 2026
Summary
MO HealthNet limits reimbursement to three ultrasound procedures per rolling year during pregnancy, with additional ultrasounds requiring medical necessity documentation. All ultrasound services must be adequately recorded in patient records with appropriate medical indications.
Action Required
Immediately: Billing team must verify all pregnancy ultrasound claims for MO HealthNet patients comply with the three-per-year limit and include proper medical necessity documentation. Update billing system to flag patients approaching the three-ultrasound limit. Providers must document medical indications in patient records using the checklist in Physician Manual Sections 13.57.B(1) and 13.57.B(2). Claims exceeding three ultrasounds without proper documentation will be denied.