Maternal-Fetal Medicine Billing Services

Maternal-fetal medicine (MFM) practices care for high-risk pregnancies. Much of the work is consultation, detailed imaging and fetal procedures rather than delivery. That changes how claims are built. Many MFM patients are referred, so the practice may bill consults or visits while another provider holds the global obstetric package.

Imaging is a large share of revenue, and it has strict documentation rules. Diagnosis coding also matters, because high-risk status must be supported on every claim. Westmont Revenue Partners connects MFM groups with vetted medical billing experts who understand this mix. This page covers what MFM billing involves and where claims are often delayed or denied.

Who this is for

• Maternal-fetal medicine physician groups
• MFM divisions inside hospitals and academic centers
• Practices that provide consults to referring OB/GYNs
• Groups with in-house ultrasound and genetic counseling
• Practices that share care with community obstetricians

What gets billed

• Initial and follow-up high-risk consultations
• Detailed (targeted) fetal anatomy ultrasound
• Follow-up and limited obstetric ultrasound
• Transvaginal ultrasound, including cervical length
• Biophysical profile and fetal Doppler studies
• Amniocentesis and other invasive fetal procedures
• Fetal non-stress testing
• Co-management of prenatal care for complex patients
• Delivery and postpartum care when the MFM team delivers
• Genetic counseling and screening discussions

Commonly billed codes

Code	Type	What it covers
76811	CPT	Detailed fetal anatomy ultrasound for a single fetus
76812	CPT	Detailed fetal anatomy ultrasound, each additional fetus (add-on)
76815	CPT	Limited obstetric ultrasound
76816	CPT	Follow-up obstetric ultrasound
76817	CPT	Transvaginal obstetric ultrasound
76818	CPT	Fetal biophysical profile with non-stress testing
76820	CPT	Doppler study of the umbilical artery
59000	CPT	Amniocentesis for diagnostic purposes
59025	CPT	Fetal non-stress test
99205	CPT	New patient office visit, high complexity
O09.90	ICD-10-CM	Supervision of a high-risk pregnancy, unspecified
O24.419	ICD-10-CM	Gestational diabetes in pregnancy, type of control not specified

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in maternal-fetal medicine

• Imaging documentation. Detailed scans require specific views and a written report. Billers compare reports to payer requirements before billing so a scan is not downgraded.
• Multiple fetuses. Twin and higher-order pregnancies change how scans are reported. A skilled biller knows which codes add on and which stand alone.
• High-risk diagnosis support. Payers look for a diagnosis that justifies the service. Billers work with clinicians to make sure the condition is documented and coded in full.
• Shared care with referring OB/GYNs. Only one provider can usually bill the global package. Billers confirm who is billing what, so MFM claims are not rejected as duplicates.
• Prior authorization for advanced testing. Some payers want approval for certain studies. Staff track requirements by payer and submit requests early.
• Facility versus office setting. Scans done at a hospital may split into professional and technical parts. Billers check the place of service on every claim.
• Repeated services. Frequent follow-up scans can hit payer frequency limits. Billers track utilization and write medical necessity letters when needed.

How Westmont can help

• Match you with vetted billing experts experienced in maternal-fetal medicine
• End-to-end revenue cycle support for consults, imaging and procedures
• Denial management, including appeals for frequency and necessity edits
• Help with credentialing and payer enrollment for new physicians
• Reporting that shows claims by service line

Frequently asked questions

Can an MFM practice bill the global obstetric package?

Only if it provides the full course of care. Most MFM groups see patients for consults or co-management, so they bill visits and procedures separately. Confirm the arrangement with the referring OB/GYN and the payer so only one claim covers the package.

Why do detailed ultrasound claims get denied?

Common reasons are missing required views, a report that reads like a limited scan, or a diagnosis that does not support the service. Billers review the report against payer rules before submitting.

How are twin pregnancies billed for ultrasound?

Many scan codes have an add-on for each extra fetus. The exact approach depends on the code and payer, so billers check the current code book and payer policy before coding multiples.

Do MFM visits need prior authorization?

Some payers require authorization for certain imaging or procedures, and requirements change often. Check each payer's current policy and build a process so requests go in before the visit.

What should I look for in an MFM billing company?

Look for experience with obstetric ultrasound, split-care situations and high-risk diagnosis coding. Ask how they handle denials and what reports you will get.

Related billing services

• OB/GYN
• Radiology (Diagnostic)
• Neonatology and NICU
• Genetics and Genomic Medicine
• Midwifery and Birth Centers