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Kevin J. Dwyer, TRICARE Management Activity
TRICARE - February 04, 2010 The ultrasound image of a baby is more and more often the very first picture new parents have of their child. Along with giving parents a picture of the growing fetus, these popular ultrasound images are also an important tool for the obstetrician caring for mother and baby.
TRICARESM covers medically necessary ultrasounds for expectant moms, but does not cover “routine ultrasounds.” So, what does this mean?
A medically necessary ultrasound is one doctors perform when they have a concern about the progression of a pregnancy. Some of the reasons a doctor might order an ultrasound include estimating gestational age, evaluating a fetus’ growth or well-being and diagnosing a multiple pregnancy. Doctors can also use an ultrasound to check the condition of a mother and fetus if prenatal care was started late in the pregnancy. These ultrasounds are covered by TRICARESM.
Some doctors may offer mothers-to-be routine ultrasounds 16 to 20 weeks into their pregnancy, or to determine the sex of the child. These ultrasounds are not covered by TRICARESM. If ultrasounds are performed without a valid medical reason beneficiaries may be responsible for payment.
TRICARESM strongly recommends mothers-to-be seek appropriate prenatal care. TRICARESM Prime covers all necessary maternity care, from the first obstetric visit through six weeks after a baby is born. Beneficiaries using TRICARESM Standard and Extra pay their normal deductibles and cost shares for office visits and inpatient maternity care.