Update on OB Ultrasounds Denied for Edit 23420

Some providers have reported denials of Obstetrical Ultrasounds when billed with the U2 modifier. The denials are for Edit 23420 - RVW OB ULTRASND MED NECESSITY.

This situation has been resolved. Providers who have denied claims for Obstetrical Ultrasound services when using modifier U2 should resubmit the claims for review.

For more information, please see Clinical Policy No.: 1K-7 Page 4-5:
5.1.1 Exemptions
a. Imaging procedures performed in the following situations are exempt from
the prior approval requirement:
1. During an inpatient hospitalization.
2. During an observation stay (this includes labor and delivery observation
stay).
3. During an emergency room visit.
4. During an urgent care visit (only for urgent care, not primary care).
5. As a referral from a hospital emergency department or an urgent care
facility.

Note: Procedures that are exempt from the prior approval requirement must
meet current North Carolina Medicaid policies that define medical necessity
criteria and unit limitations for claims payment. Bypassing prior approval by
having the procedures performed in the emergency room is not a guarantee
of payment.