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Coverage criteria policies

Termination of Pregnancy – Minnesota Health Care Programs

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for termination of pregnancy.

Coverage

These services are not covered, under the Plan, but may be covered through another source such as the state, county federal government or tribe. To find out more about these services call the Minnesota Health Care Programs Helpdesk at (651) 431-2670 or 1-800-675-3739 (toll-free).

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

59840

Induced abortion, by dilation and curettage

59841

Induced abortion, by dilation and evacuation

59850

Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;

59851

Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation

59852

Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed intra-amniotic injection)

59855

Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines;

59856

Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation

59857

Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed medical evacuation)

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. This information is not the same for Medicare. If you have questions or would like help, please call Member Services at 952-883-7979 or 1-800-233-9645.

References

Portions of the contents of these coverage criteria relating to Minnesota Public Programs medical coverage criteria are taken directly from the Minnesota Health Care Programs Provider Manual at:
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_
CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_137809

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Policy activity

  • 01/01/1994 - Date of origin
  • 07/05/2017 - Effective date
Review date
  • 05/2017
Revision date
  • 05/10/2016

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