Expanded Maternity Ultrasound Coverage

The TRICARE Management Activity has announced that fetal ultrasounds are now a covered TRICARE benefit when they are performed due to medical necessity.

Some situations where ultrasounds are medically necessary include, but are not limited to:

• estimating gestational age
• evaluating fetal growth
• evaluating biophysical fetal well-being

Ultrasounds can also be used to evaluate suspected ectopic pregnancies, diagnose and evaluate suspected multiple births, confirm cardiac activity and evaluate a fetus’ condition for late registrants for prenatal care.

According to the American College of Obstetricians and Gynecologists, ultra-sonography should only be performed when there is a alid medical indication. A physician is not obligated to perform ultra-sonography on a patient who is a low risk patient with no medical indications.

Some providers offer patents routine ultrasound screening as part of the scope of care after 16-20 weeks of gestation. TRICARE does not cover routine ultrasound screening or the use of ultrasound to determine the baby’s gender. Only maternity ultrasound with a valid medical indication that constitutes medical necessity is covered by TRICARE.

Previous TRICARE policy limited the use of maternity ultrasounds to the diagnosis and management of high-risk pregnancies, pregnancies with a reasonable probability of neonatal complications.

If you have additional questions regarding your ultrasound options or maternity benefits, please contact TriWest at 1-888-TRIWEST (1-888-874-9378).