NT scan & tricare prime — The Bump
Military Families

NT scan & tricare prime

Hi all!

Quick intro - my hubby is a pilot in the Air Force. We have a 2 yr dd and I'm pregnant with our second.

I'm using a new OB practice with this pregnancy - referred off base. This office offers the NT scan at 12 wks as they have the equipment and trained personnel to do it. It was not offered at my previous OB. Will Tricare Prime cover this scan?? Anyone have experience with this? I called tricare, the lady I spoke with was about as helpful as tits on a bull (sorry lol that's my moms expression). All she kept saying was only scans that are "medically necessary" are covered. Soooo how does one determine that? Is it all in how the dr office codes the scan when submitting the claim?

Thanks in advance for any input!!


Married 8.1.2010
DD #1: Arrived 10.7.2011
TTC #2 Since March 2013
BFP 5.20.2013, EDD 1.26.2014, natural mc @ 5 wks 5.25.2013
BFP 6.21.2013, EDD 3.14.2014, Twins - missed mc @ 7w6d, D&C 8.6.2013
BFP 10.7.2013, EDD June 20 2014 - It's a GIRL!   


BabyFruit Ticker

Re: NT scan & tricare prime

  • I'm seeing an on-base OB, and they offer NT scans for everyone.  

    I would imagine that it depends on how your off-base OB codes the ultrasound. If it's coded as "medically necessary" then you should be covered.  You might even talk to the billing person at your OB office to see how they normally handle this for Tricare patients.  And maybe try calling Tricare back hoping you can speak with someone more helpful this time :-)
    imageDSC_9275  image



    Baby Birthday Ticker Ticker
  • @Avion22 Sometimes I wish we had on-base OBs here as it seems like it would make all of this simpler!!
    That's a great suggestion, I'll talk to billing at the practice. I'm going in Thursday for my intake, so I'll try to get to the bottom of it then... Maybe they can tell me. It really seems like if they code it appropriately as medically necessary than it should be covered!


    Married 8.1.2010
    DD #1: Arrived 10.7.2011
    TTC #2 Since March 2013
    BFP 5.20.2013, EDD 1.26.2014, natural mc @ 5 wks 5.25.2013
    BFP 6.21.2013, EDD 3.14.2014, Twins - missed mc @ 7w6d, D&C 8.6.2013
    BFP 10.7.2013, EDD June 20 2014 - It's a GIRL!   


    BabyFruit Ticker
    Avion22
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  • I had an off base ob and did the nt scan and it was covered by tricare prime. I'm not sure how it was coded though.
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    ktwils2010
  • Agreed. I think its all in how they code it. I am tricare prime remote (no MTF within 70 miles) and they covered all my scans. Because I had a miscarriage previously, I had a scan about 6, 12 and 20 weeks. I also had a 4d at 30 weeks which was not covered. My OB ran a few extra tests and so there were a few things here and there that was not covered but overall we can't complain. I'd say less than $100 through both pregnancies. I would call and talk to the tricare lady at the clinic. Ours knew right away if it was something we would have to pay for. Good luck!!
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    Pregnancy #1 EDD 1/20/13, D&C for unexplained miscarriage at 12w
    Pregnancy #2 EDD 8/28/2013, Carson was born on 6/28/2013 at 31w - spent 37 days in the NICU
    ktwils2010
  • TRICARE will cover ultrasounds used to:

    Estimate gestational age
    Evaluate fetal growth
    Conduct a biophysical evaluation for fetal well-being
    Evaluate a suspected ectopic pregnancy
    Define the cause of vaginal bleeding
    Diagnose or evaluate multiple gestations
    Confirm cardiac activity
    Evaluate maternal pelvic masses or uterine abnormalities
    Evaluate suspected hydatidiform mole
    Evaluate the fetus's condition in late registrants for prenatal care
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  • TRICARE will cover ultrasounds used to:

    Estimate gestational age
    Evaluate fetal growth
    Conduct a biophysical evaluation for fetal well-being
    Evaluate a suspected ectopic pregnancy
    Define the cause of vaginal bleeding
    Diagnose or evaluate multiple gestations
    Confirm cardiac activity
    Evaluate maternal pelvic masses or uterine abnormalities
    Evaluate suspected hydatidiform mole
    Evaluate the fetus's condition in late registrants for prenatal care

    Yes.... This what the lady I spoke with at tricare read to me, from the internet. But she could not tell me if the NT scan fell under one of these categories - just back to is it medically necessary or not.


    Married 8.1.2010
    DD #1: Arrived 10.7.2011
    TTC #2 Since March 2013
    BFP 5.20.2013, EDD 1.26.2014, natural mc @ 5 wks 5.25.2013
    BFP 6.21.2013, EDD 3.14.2014, Twins - missed mc @ 7w6d, D&C 8.6.2013
    BFP 10.7.2013, EDD June 20 2014 - It's a GIRL!   


    BabyFruit Ticker
  • I think it would be covered under "conduct a biophysical evaluation for fetal well-being".

    I'm having one on Jan. 2nd and I hope it'll be covered. My doc said most insurance companies will cover it when they submit the claim. I'm not even going to bother to call Tricarw about it because I know they'll give me a run around answer.
    BabyFruit Ticker



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