Does Medicare Cover a 12-week Ultrasound?

Medicare Benefits Solutions
Apr 29, 2021

Most of the eligible population who receive health insurance from Medicare are more than 65 years old. However, those impaired by a qualifying disability or end-stage renal disease receiving Social Security disability insurance payments for two years can enroll in Medicare. People grouped in this excepted category of Medicare recipients may include women between the ages of 18 and 44 who are within the possibility of child-bearing years.

Average 12-week Ultrasound Expectations

The first ultrasound that expectant mothers receive occurs in the 12th week of their pregnancy following the first trimester. It is usual for the experience to bring up many questions about the pregnancy’s healthfulness and the baby’s estimated due date. Since it is still early in the pregnancy, many developmental milestones for the fetus have not happened yet. However, doctors can detect early signs of possible issues that should receive careful consideration, such as a tilted uterus or other complications.

At 12 weeks, it’s unlikely that an obstetrician can determine gender. However, a heartbeat is detectable, and the doctor can estimate a delivery due date. Pictures are attainable at a 12-week ultrasound appointment, and it’s also a good opportunity for the obstetrician to receive lab results ordered during the first trimester.

The mother may have particular needs, which the OB/GYN will consider when determining how best to conduct the ultrasound. The doctor may perform the ultrasound by inserting a transducer vaginally or by gliding the instrument over the woman’s abdomen. At this stage of pregnancy, clear images aren’t always possible because the mother is not that far along. So, it’s often preferable to use a vaginal transducer over an external one. 

Sensible Questions to Ask at the 12-week Ultrasound

Mothers must communicate clearly with their providers and ask plenty of questions whenever they arise because not knowing, assuming, or obscuring the pregnancy can make maintaining the health of each trimester an overwhelming task. A mother may want to clear up some different things at the appointment for the 12-week ultrasound, such as:

• Do treatments for my pre-existing health conditions cause a risk for my pregnancy?
• Are there any foods or drinks that I should refrain from consuming? 
• Are there any pre-existing health conditions that can be a risk to the health of my pregnancy? 
• Should I reduce or avoid any specific physical activities? 
• What prescription medications or over-the-counter drugs are safe? 
• How much weight should I anticipate gaining each month?
• If I experience bleeding, spotting, or cramping, should I be concerned?

Whether you have a pre-existing or disabling health condition, you want to inform your doctor of any supplements or medications you are taking to treat them. It’s incredibly critical to make your doctor aware of any treatment you need to have if you are a mother with chronic conditions. Your provider can determine if they pose any threat to your pregnancy or if specific changes are required in your care.

12-week Ultrasound and Medicare Coverage

Pregnant recipients can receive Medicare benefits under Part A or Part B depending on where the mother receives care. For example, Part B covers diagnostic services and outpatient appointments. In this situation, the 12-week ultrasound is a routine diagnostic service. However, that does not mean that recipients will not be responsible for paying any appropriate deductible amounts, coinsurance, or co-pays.

A doctor’s documentation may be necessary for the preauthorization of outpatient visits and diagnostic services that are needed more frequently for high-risk pregnancies. However, Medicare recipients may still receive the same coverage for some of these services as if they were routine. You may enhance Medicare benefits or reduce associated costs for specific assistance with additional help from some of the available Medicare Advantage plans.

Also, some recipients who have low income may be eligible and qualify for Medicaid services. Your state’s local Medicaid office and your Medicare Advantage provider can provide more information on these particular opportunities.