Routine maternity care/codes

Routine maternity is not a $0-cost-share preventive benefit. Go to the Member Inquiry tool > Additional benefits > Maternity to see the member's routine maternity benefits. 

Self-funded plans with a Maternity exclusion for dependents will deny all services except routine lab work listed below.

Bacteriuria screening

Use codes:

  • 81000-81003, 87086

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

At 12-16 weeks gestation or first prenatal visit

USPSTF Rating: A

Blood tests

Complete blood count

CPT codes: 85025*, 85027*

Diagnosis codes

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

On a routine basis for iron deficiency anemia

Blood typing:

CPT code: 86900*

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

Gestational diabetes screening

CPT codes: 82947, 82948, 82950, 82951, 82952

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

For women 24-28 weeks pregnant and those at high risk for gestational diabetes

USPSTF Rating: B

HRSA requirement

Hemoglobin/hematocrit:

CPT codes: 85014*, 85018*

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

On first prenatal visit

Hepatitis B screening:

CPT codes: 86704, 86340*

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

USPSTF Rating: A

Obstetric panel:

CPT codes: 80055, 80081

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

Priority Health routine pre-natal care as preventive

RBC antibody screen:

CPT code: 86850*

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

Rh compatibility:

CPT code: 86901

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

First prenatal visit and follow up for women at high risk

USPSTF Rating: A

Rubella antibody:

CPT code: 86762*

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

USPSTF Rating: B

Venipuncture:

CPT codes: 36415, 36416

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

Bill with preventive blood studies

Breastfeeding support

Counseling, education code: S9443

Supplies codes:;

  • A4281-AA4286
  • E0602
  • E0603

For pregnant and lactating women

USPSTF Rating: B

HRSA requirement

Cervical cancer screening/Pap smear

CPT codes:

  • 88141-88155
  • 88164-88167
  • 88174
  • 88175

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

HRSA requirement

Chlamydia testing

CPT codes

  • 87110
  • 87270
  • 87320
  • 87490
  • 87491
  • 87492

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

USPSTF Rating: B

Gonorrhea testing

CPT codes

  • 87850
  • 87590
  • 87591
  • 87592

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

USPSTF Rating: B

HIV testing

CPT codes

  • 86701
  • 86702
  • 86703
  • 87389
  • 87806

HCPCS codes:

  • G0432
  • G0433
  • G0435

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

USPSTF Rating: A

Human Papillomavirus (HPV) testing

CPT codes

  • 87623
  • 87624
  • 87625

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

Prenatal, post-natal and delivery care

CPT codes:

  • 59400-59410
  • 59425-59515
  • 59610-59622

Diagnosis codes not specified

OR

CPT codes:

  • 99201-99215
  • 99241-99245

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

Priority Health may pay routine pre-natal care as preventive

Cost-sharing applies to global and delivery codes for HSA plans

Syphilis testing

CPT code: 86592*

Diagnosis codes:

  • O07.0-O9a.53
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

USPSTF Rating: A

Ultrasound

CPT codes: 76801 - 76817

Diagnosis codes not specified

Priority Health routine prenatal care as preventive

Vaccinations

No diagnosis codes are specified for vaccinations.

See the preventive vaccines coding table page for coverage information