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.

* = Modifier 33 may be submitted to identify the service was performed for an indication described under the Priority Health Preventive Health Care Guidelines, for commercial products only

Bacteriuria screening

Use codes:

  • 81000-81003, 87086

Diagnosis codes:

  • O07.0-O9a.53
  • Z32.01
  • 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
  • Z32.01
  • 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
  • Z32.01
  • 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
  • Z32.01
  • 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
  • Z32.01
  • 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
  • Z32.01
  • 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
  • Z32.01
  • 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
  • Z32.01
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

Rh compatibility:

CPT code: 86901

Diagnosis codes:

  • O07.0-O9a.53
  • Z32.01
  • 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
  • Z32.01
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

USPSTF Rating: B

Venipuncture:

CPT codes: 36415, 36416

Diagnosis codes:

  • O07.0-O9a.53
  • Z32.01
  • 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
  • K1005

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
  • Z32.01
  • 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
  • Z32.01
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

USPSTF Rating: B

Counseling to reduce risk for post-partum depression

CPT codes

  • 96127
  • 99401-99404
  • 99411-99412

USPSTF Rating B

Gonorrhea testing

CPT codes

  • 87850
  • 87590
  • 87591
  • 87592

Diagnosis codes:

  • O07.0-O9a.53
  • Z32.01
  • 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
  • Z32.01
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

USPSTF Rating: A

Human Papillomavirus (HPV) testing

CPT codes

  • 87623
  • 87624
  • 87625
  • 87626

Diagnosis codes:

  • O07.0-O9a.53
  • Z32.01
  • 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
  • Z32.01
  • 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

Streptococcus B testing

CPT codes:

  • 87653

Diagnosis codes:

  • O07.0-O9a.53
  • Z32.01
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

Syphilis testing

CPT codes:

  • 86592*
  • 86593*
  • 86780*

Diagnosis codes:

  • O07.0-O9a.53
  • Z32.01
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

USPSTF Rating: A

Ultrasound

CPT codes: 76801 - 76817

Diagnosis codes:

  • O07.0-O9a.53
  • Z32.01
  • Z33.1
  • Z34.00-Z37.9
  • Z39.0-Z39.2

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