2.0 DESCRIPTION
Maternity care is the medical services related
to conception, delivery and pregnancy loss, including prenatal and
postpartum care (generally through the sixth post-delivery week),
and treatment of complications of pregnancy.
3.0 POLICY
3.1 Services
and supplies associated with antepartum care (including well-being
of the fetus), childbirth, postpartum care, and complications of
pregnancy may be covered.
3.2 The maternity care benefit includes,
but is not limited to, the following prenatal screening tests:3.2.1 Anemia Screening:
3.2.2 Asymptomatic Bacteriuria, Urinary
Tract, or Other Infection Screening. Screen with urine culture for
women 12-16 weeks gestation, or at first prenatal visit, if later.
3.2.3 Gestational Diabetes Mellitus
Screening. Screen women 24-28 weeks pregnant and those at high risk
of developing gestational diabetes.
3.2.4 Hepatitis B Screening. Screen
pregnant women for HBsAG during the prenatal period.
3.2.5 Human Immunodeficiency Virus
(HIV) Infection Screening.
3.2.6 Rh Incompatibility Screening.
Screen all pregnant women and provide follow-up testing for pregnant
women at high risk.
3.2.7 Syphilis Infection Screening.
3.2.8 Other screening tests as recommended
by the United States Preventive Services Task Force.
3.3 Genetic testing is considered preventive rather
than active medical treatment. However, under the family planning
benefit, genetic testing, including testing done as part of routine
prenatal care, is covered when performed in certain high risk situations.
For the purpose of the TRICARE benefit, genetic testing may include
specific tests to detect developmental abnormalities as well as
tests for specific genetic defects.
3.4 The mother and child hospital Length-of-Stay
(LOS) benefit may not be restricted to less than 48 hours following
a normal vaginal delivery and 96 hours following a cesarean section.
The decision to discharge prior to those minimum LOSs must be made
by the attending physician in consultation with the mother.
3.5 Maternity care for pregnancy resulting from
noncoital reproductive procedures may be cost-shared. Where the
contractual arrangements do not specify an amount for reimbursement
for medical expenses, the full amount of all undesignated payments
shall be deemed to be for medical expenses incurred by the surrogate
mother. TRICARE will cost-share on the remaining balance of otherwise covered
benefits related to the surrogate mother’s medical expenses after
the contractually agreed upon arrangement has been exhausted.
3.6 For pregnancies in which the TRICARE beneficiary
is a surrogate mother, services and supplies associated with antepartum
care, childbirth, postpartum care, and complications of pregnancy
may be cost-shared.
3.8 Progesterone therapy for the prevention of
preterm birth is covered only for weekly injections of 17 alpha-hydroxyprogesterone
caproate between 16 and 36 weeks of gestation for pregnant women with
a documented history of a previous spontaneous birth at less than
37 weeks of gestation.
4.0 EXCLUSIONS
4.1 Oral progesterone
therapy or injections of 17 alpha-hydroxyprogesterone caproate are NOT covered
for other high risk factors for preterm birth, including, but not
limited to multiple gestations, short cervical length, or positive
fetal tests for cervicovaginal fetal fibronectin.
4.2 Services
and supplies related to noncoital reproductive procedures.
4.3 Home Uterine
Activity Monitoring (HUAM), telephonic transmission of HUAM data,
or HUAM-related telephonic nurse or physician consultation for the
purpose of monitoring suspected or confirmed pre-term labor is unproven.
4.4 Subcutaneous
terbutaline pump and home use of maintenance subcutaneous terbutaline
to suppress labor is unproven.
4.5 Lymphoctye or paternal leukocyte
immunotherapy in the treatment of recurrent spontaneous fetal loss
is unproven.
4.6 Salivary estriol test for preterm labor is
unproven (CPT procedure code 82677).