National Medical Policy - Health Net

Posted: April 2011 

National Medical Policy 

Subject: 

Policy Number: 

Three Dimensional Obstetric Ultrasound 

NMP30 

Effective Date*: September 2003 

Updated: July 2006, August 2007, July 2009, April 2011 

This National Medical Policy is subject to the terms in the 

IMPORTANT NOTICE 

at the end of this document 

The Centers for Medicare & Medicaid Services (CMS) 

For Medicare Advantage members please refer to the following for coverage 

guidelines first: 

Use 

Source 

Reference/Website Link 

National Coverage Determination 

(NCD) 

National Coverage Manual Citation 

Local Coverage Determination (LCD) 

Article (Local) 

Other 

X None Use Health Net Policy 

Instructions 

• Medicare NCDs and National Coverage Manuals apply to ALL Medicare members 

in ALL regions. 

• Medicare LCDs and Articles apply to members in specific regions. To access your 

specific region, select the link provided under “Reference/Website” and follow the 

search instructions. Enter the topic and your specific state to find the coverage 

determinations for your region 

• If more than one source is checked, you need to access all sources as, on 

occasion, an LCD or article contains additional coverage information than 

contained in the NCD or National Coverage Manual. 

• If there is no NCD, National Coverage Manual or region specific LCD/Article, 

follow the Health Net Hierarchy of Medical Resources for guidance. 

Current Policy Statement (Update April 2011 – A Medline search failed to reveal 

any studies that would cause Health Net, Inc. to change its current position) 

Health Net, Inc. considers three dimensional (3D) ultrasound investigational and 

therefore, not medically necessary. Although 3D ultrasound is technically a promising 

imaging tool for any number of diseases or conditions, the role of this technology in 

Three Dimensional Obstetric Ultrasound Apr 11 1


reaching the correct diagnosis has not been clearly translated into clinical 

improvement of patient outcome. 

Codes Related To This Policy 

ICD-9 Codes 

V22.0-V22.2 Normal pregnancy 

V23.0-V23.9 Supervision of high-risk pregnancy 

CPT Codes 

76375 

Coronal sagittal, multiplanar, oblique, 3-Dimensional and/or 

holographic reconstruction of computerized tomography, 

magnetic resonance imaging, or other topographic modality 

(may be considered medically unnecessary and denied if 

equivalent information to that obtained from the test has 

already been provided by another procedure (magnetic 

resonance imaging, ultrasound, angiography, etc.), or could be 

provided by a standard CT Scan (2-Dimensional) without 

reconstruction (deleted 12/31/05) 

76376 3D rendering with interpretation and reporting of computed 

tomography, magnetic resonance imaging, ultrasound, or other 

tomographic modality; not requiring image post processing on 

an independent workstation 

76377 3D rendering with interpretation and reporting of computed 

tomography, magnetic resonance imaging, ultrasound, or other 

tomographic modality; requiring image post processing on an 

independent workstation 

HCPCS Codes 

N/A 

Scientific Rationale – Update July 2009 

Ultrasonography in pregnancy should be performed only when there is a valid 

medical indication. The American College of Obstetrics and Gynecology (ACOG) 

[2009] stated, "The use of either two-dimensional or three-dimensional 

ultrasonography only to view the fetus, obtain a picture of the fetus, or determine 

the fetal sex without a medical indication is inappropriate and contrary to responsible 

medical practice." 

Current guidelines on ultrasonography in pregnancy from the American College of 

Obstetricians and Gynecologists (2009) state: "The technical advantages of 3- 

dimensional ultrasonography include its ability to acquire and manipulate an infinite 

number of planes and to display ultrasound planes traditionally inaccessible by 2- 

dimensional ultrasonography. Despite these technical advantages, proof of a clinical 

advantage of 3-dimensional ultrasonography in prenatal diagnosis in general is still 

lacking. Potential areas of promise include fetal facial anomalies, neural tube 

defects, and skeletal malformations where 3-dimensional ultrasonography may be 

helpful in diagnosis as an adjunct to, but not a replacement for, 2-dimensional 

ultrasonography. Until clinical evidence shows a clear advantage to conventional 2- 

dimensional ultrasonography, 3-dimensional ultrasonography is not considered a 

required modality at this time." 



Scientific Rationale – Update August 2007 

According to the American College of Obstetrics and Gynecology (ACOG) practice 

bulletin, Ultrasonography in Pregnancy, “Proof of a clear advantage of 3-dimensional 

ultrasonography in prenatal diagnosis is not present when compared with 2- 

dimensional imaging by an experienced clinician. Therefore, 3-dimensional imaging is 

not considered a required modality at this time.” 

Wang et al. (2007) investigated the prenatal diagnostic accuracy of two-dimensional 

ultrasound (2DUS) alone versus 2DUS in conjunction with three-dimensional 

ultrasonography (3DUS) including orthogonal display (OGD) and three-dimensional 

extended imaging for cleft lip and primary palate. Fetuses being suspected of having 

a facial cleft by previous ultrasound examination or family history were examined 

sequentially with 2DUS and then 3DUS. Of a total of 30 infants, 22 had cleft lip and 

nine also had cleft palate at birth. The use of 2DUS with or without 3DUS correctly 

identified all cases of cleft lips prenatally. However, the use of 2DUS in conjunction 

with 3DUS correctly identified more cleft primary palate than 2DUS alone (88.9% vs 

22.2%). Cleft primary palate was well demonstrated in both the multi-slice view 

(MSV) and OGD modes. In one case, a cleft palate was shown in the MSV mode but 

not in the Oblique view(OBV) mode. All the unaffected fetuses were reported as no 

cleft palate with the use of MSV mode. The investigator concluded the combined 

approach of 2DUS and 3DUS with both OGD and MSV modes significantly improved 

the prenatal detection rate for a cleft palate compared with 2DUS alone (88.9% vs 

22.2%) without decreasing the specificity. 

Goncalves et al. (2005) performed a review of the published literature on 3- 

dimensional ultrasound (3DUS) and 4-dimensional ultrasound (4DUS) in obstetrics to 

determine whether 3DUS adds diagnostic information to what is currently provided 

by 2-dimensional ultrasound (2DUS) and, if so, in what areas. A PubMed search 

found 525 articles reporting on the use of 3DUS or 4DUS in obstetrics related to the 

subject of the review. Articles describing technical developments, clinical studies, 

reviews, editorials, and studies on fetal behavior or maternal-fetal bonding were 

reviewed. The reviewers found that three-dimensional ultrasound provides 

additional diagnostic information for the diagnosis of facial anomalies, especially 

facial clefts. They also found evidence that 3DUS provides additional diagnostic 

information in neural tube defects and skeletal malformations. Large studies 

comparing 2DUS and 3DUS for the diagnosis of congenital anomalies have not 

provided conclusive results. They noted preliminary evidence suggests that 

sonographic tomography may decrease the examination time of the obstetric 

ultrasound examination, with minimal impact on the visualization rates of anatomic 

structures. The reviewers concluded three-dimensional ultrasound provides 

additional diagnostic information for the diagnosis of facial anomalies, evaluation of 

neural tube defects, and skeletal malformations. Additional research is needed to 

determine the clinical role of 3DUS and 4DUS for the diagnosis of congenital heart 

disease and central nervous system anomalies. Future studies should determine 

whether the information contained in the volume data set, by itself, is sufficient to 

evaluate fetal biometric measurements and diagnose congenital anomalies. 

In a prospective randomized pilot study among low risk women with singleton 

fetuses in the second and third trimester, Lapaire et al. (2007) assessed the impact 

of three-dimensional (3D) versus two-dimensional (2D) ultrasound (US) on 

maternal-fetal bonding. Sixty women were randomized to either 2D US or 3D US 

and the effects were recorded with standardized questionnaires. Although the 



quality of 2D US, assessed by the examinator, was superior to 3D US, maternal 

recognition was higher with 3-D US. With 2D US, nulliparous patients had 

significantly more difficulties visualizing the fetus, than multiparous. However, the 

maternal preference of 3D US had no significant impact on maternal-fetal bonding. 

The investigator concluded ultrasound had no significant effect on maternal-fetal 

bonding. Three-dimensional images may facilitate recognition of the fetus, but 3D US 

did not have higher impact on maternal-fetal bonding. This finding may be a reason 

not to consider 3D ultrasound for routine scanning 

According to the American Institute of Ultrasound in Medicine, “Currently, twodimensional 

(2D) gray-scale real-time sonography is the primary method of 

medically indicated anatomic imaging with ultrasound. The term three-dimensional 

(3D) ultrasound refers to the acquisition of imaging data from a volume of tissue. 

This volumetric data can be displayed as slabs of varying thickness, multiplanar 

reconstruction or as a rendered image. The 2D display remains the primary method 

of image presentation regardless of the method of acquisition. While 3D ultrasound 

may be helpful in diagnosis, it is currently an adjunct to, but not a replacement for 

2D ultrasound. As with any developing technology, its clinical value may improve and 

its diagnostic role will be periodically re-evaluated” 

Scientific Rationale 

Two-dimensional (2D) sonography is the traditional way we have been using 

ultrasound in all areas of medicine to display normal and abnormal anatomy. More 

recently, three dimensional (3D) ultrasound has emerged as the novel sonographic 

method that can enhance diagnostic capability over standard 2D ultrasound. Even 

though this ability to display a 3D image may become one of the most powerful 

recent advances in sonography, critics of the technique feel that three-dimensional 

ultrasound has been over rated and that the training afforded to 2D sonographers 

enables them to perform 3D reconstructions in their mind’s eye, with similar results 

as those described with actual 3D displays. 

Numerous studies conducted on the use of 3D ultrasound demonstrate that this noninvasive 

method is technically feasible and suggest potential benefits for some of the 

proposed indications. However, there is a paucity of high quality direct evidence 

demonstrating the impact on diagnostic thinking and therapeutic decision-making. In 

addition, the techniques of acquiring the capabilities to perform 3D ultrasound, 

appropriate patient selection criteria, and interpreting the results are not well 

standardized. There is no adequate evidence that 3D ultrasound can prevent or 

retard the development and/or progression of the long-term complications of any 

diseases or conditions; nor is there evidence that 3D ultrasound can prolong the life 

of patients. Prospective clinical studies are needed to determine the clinical value of 

3D ultrasound over standard 2D ultrasound in the assessment of patients. The 

following enumerates the potential uses of 3D ultrasound. 

2D ultrasound is used routinely in obstetrics and gynecology. Today, nearly all 

pregnant women undergo at least one ultrasound during her pregnancy. These 

ultrasounds are designed to assess fetal well-being and gestational age. The 

traditional 2D ultrasound uses high-frequency sound waves to bounce off the 

surfaces and structures of the fetus producing echos, which can be assessed on the 

video screen. Although clinicians are generally adept at using this information, the 

image remains distorted and vague to say the least. In the last couple of years, the 

creation of 3D ultrasound for use in obstetrics has come to fruition. 3D ultrasound is 



done the same way as the traditional ultrasound with the addition of software to 

enhance the image and produce a three dimensional image. 

A further benefit of 3D ultrasonography is that it can provide caregivers in primary 

facilities with less experience and expertise in ultrasonography an opportunity for 

remote referrals and consultations for complicated cases. 3D images can be digitally 

stored with the complete data set conveyed by an Internet connection from the 

primary caregiver to experts across the world. This allows the consultant to have an 

entirety of imaging information required to make a diagnosis. Furthermore, the online 

transmission enables feedback and interaction with a specialist at the time of or 

immediately after an ultrasonographic examination, thus limiting the need for further 

referrals. Telemedicine has only begun to demonstrate itself as a useful tool and 3D 

ultrasonography is ideally suited to promote this upcoming aspect of care in 

medicine. Imaging physicians already use 3D volume imaging techniques in CT and 

MR and are likely to become comfortable working in a volume or multiplanar 

environment in ultrasound as well. 

One of the most consistently used justifications for the use of obstetric 

ultrasonography is that accurate diagnosis of fetal malformations before delivery can 

provide both health care providers and parents a number of management options 

that before the advent of this technique were unavailable. However, reports from the 

Routine Antenatal Diagnostic Imaging with Ultrasound (RADIUS) trial have 

challenged this particular tenet. These researchers indicated that screening with 

ultrasonography did not significantly influence the management or outcome of 

pregnancies complicated by congenital malformations. Its role in gynecology has not 

been clearly established. It may be indicated only when equivalent information 

resulting in clinical improvement in fetal and maternal outcome cannot be obtained 

by another standard test (2D ultrasound, magnetic resonance imaging, CT Scan, 

angiography, etc.). 3D ultrasound may be useful in differentiating between a septate 

and a bicornuate uterus or to determine the exact location of a malpositioned 

intrauterine device (IUD). 

The fetal brain is one of the areas where 3D ultrasound has been most helpful. 

Surface rendering of the skull is instrumental in evaluating the status of cranial 

sutures and determining whether or not an abnormal head shape is secondary to 

craniosynostosis. Three-dimensional surface rendering is also particularly helpful in 

the evaluation of other surfaces of the fetal head and face, such as the fetal ears, 

which are not normally focused upon using standard 2D cross sectional imaging. 

Surface imaging of the fetal face using 3D sonography has probably been the most 

notable area of study, not only in the ultrasound literature but also in the lay press 

where patients have been able to see the face of their unborn baby more clearly than 

ever before. Everyone agrees that 3D sonography of the face is not a screening 

technique but an adjunct to a good 2D scan. To date, it is not yet possible to detect 

dysmorphologic features using 3D surface rendering although it is hoped that as the 

techniques improve, the dysmorphologic fetal facies will be detectable. It is the 

evaluation of the fetal cleft lip and palate that has gotten the most attention in the 

literature. 

Three-dimensional imaging of the normal and abnormal extremities has been studied 

extensively using both multi-planar reconstruction and surface rendering. Several 

studies have described fetal skeletal dysphasia’s viewed with 3D ultrasound, where 

practitioners found that 3D provided additional information on affected fetuses as 

compared to 2D. On the other hand, other investigators have not been as 



enthusiastic about the role of 3D for fetuses with these malformations, thus requiring 

further investigation to come to a consensus. Opinions that 3D provides diagnostic 

details not available using two-dimensional ultrasound remains somewhat anecdotal 

and restricted to small case series. It is clear from several reports that although 3D 

made additional diagnostic information possible, the technique was not necessary for 

definitive diagnosis of spina bifida. 3D ultrasounds, however, did display the level of 

the defect more accurately than with conventional scanning. Scoliosis resulting from 

vertebral body anomalies was also recognized more easily on a single 3D rendered 

image whereas multiple standard 2D images were needed to make the same 

diagnosis. 

Evaluation of the fetal heart is an intense area of research, however, evaluation of 

the heart in 3D can be tricky and requires Doppler gated capabilities. There is still 

much work to be done to bring 3D imaging of the heart up to a standard currently 

possible using 2D operated by trained personnel. Other areas of investigation include 

fetal genital scanning where the fetal perineum can be visualized, although to date, 

the performance of 3D technology is reportedly not as good in evaluating fetal 

genitals than is 2D imaging alone. By far, the most important function of first 

trimester 3D scanning may become the evaluation of the nuchal translucency 

measurement of fetuses 11-14 weeks. 

Another important clinical application of 3D is volume measurements calculations 

based on 3D volume acquisition. Current literature has demonstrated the accuracy of 

volume based 3D ultrasonography measurement on follicle aspiration performed 

using transvaginal needle guided technique. Other practitioners have also shown that 

3D sonographic methods provide accurate measurements of serial fetal lung volume 

measurements for the prenatal detection of pulmonary hypoplasia, the fetal thoracolumbar 

spine as well as kidneys, brain, liver and heart. Additionally, at the current 

time fetal cardiac malformations, which remain the least identifiable of major 

malformations, have thus far had only limited benefit from this 3D technique 

because of motion artifact. Hypothetically, if the 3D examination demonstrates an 

abnormality not seen with 2D imaging, then clinical management of patients may be 

altered. 

Craniofacial abnormalities that have been identified with 3D ultrasound include cleft 

lip or palate, micrognathia, midface hypoplasia, facial dysmorphia, intracranial 

abnormalities, hypotelorism, holoprosencephaly and skull defects in the second- and 

third-trimester. In expert hands, a 2D ultrasound is sufficient and 3D ultrasound 

does not add any valuable diagnostic information. Three-dimensional ultrasound may 

facilitate the understanding of the lesion by the parents and facilitate communication 

with the plastic surgeons. However, these potential benefits need to be carefully 

weighed against the costs of the ultrasound instrumentation, increased examination 

time and training of personnel. 

Computer technology and software advanced sufficiently in the past five years to 

allow real-time reconstruction of 3D images and their visualization and manipulation 

on inexpensive desktop computers. Nevertheless, ultrasound imaging still suffers 

from several disadvantages related to its 2 dimensional nature, which 3D imaging 

attempts to address. Despite decades of exploration, it is only in the past five years 

that 3D imaging in ultrasound moved out of the research laboratory to become a 

commercial product for routine clinical use. 



A major advantage of 2D ultrasound is its flexibility, allowing the sonologist to 

manipulate the transducer and view the desired anatomical section. Paradoxically, 

this advantage is one of its weaknesses that 3D imaging attempts to address. Using 

conventional ultrasonography, only one thin slice of the patient can be viewed at any 

time, and the location of this image plane is controlled by physically manipulating the 

transducer orientation. It is difficult to place the 2D image plane at a particular 

location within an organ, and even more difficult to find the same location again 

later. Thus, 2D US is not optimal for planning or monitoring therapeutic procedures, 

or for performing quantitative prospective or follow-up studies. 

Consequently, the diagnostician or physician must mentally integrate many 2D 

images to form an impression of the 3D anatomy and pathology. This process is 

time-consuming and inefficient, but more important, variable and subjective. 

Most 3D ultrasound systems have used conventional ultrasound machines with 1D 

arrays to collect multiple 2D images and reconstruct them into 3D images. Two 

important criteria must be met to avoid inaccuracies or distortions: (1) the relative 

position and angulation of the acquired 2D images must be accurately known so that 

the reconstructed 3D image is not distorted; and (2) 

the image acquisition must be carried out rapidly and/or gated to avoid artifacts 

caused by respiratory, cardiac and involuntary motion. 

Although 3D ultrasound is a promising tool to image many anatomical sites in the 

fetus and the adult female, its clinical benefits are still being researched. There is no 

question that the pictures far exceed the surface detail of the traditional grainy, 

black-and-white, 2D ultrasound images. However, at the present time 3D ultrasound 

is rarely critical in reaching the correct diagnosis and it may take a few more years 

before the place of 3D ultrasound as a diagnostic tool can be defined more precisely. 

There are scant outcome studies and much research is needed as the 3D technology 

is further developed. 

Review History 

September 9, 2003 

July 2006 

August 2007 

July 2009 

April 2011 

Medical Advisory Council 

Update – no revisions 

Update – no revisions 

Update. No Revisions. Codes reviewed. 

Update. Added Medicare Table. No revisions. 

Patient Education Websites 

English 

1. American College of Radiology, Radiological Society of North America. 

Ultrasound: Obstetric. Available at: 

http://www.radiologyinfo.org/en/info.cfm?PG=obstetricus 

Spanish 

1. American College of Radiology, Radiological Society of North America. 

Ultrasonido obstétrico. Acesso en: 

http://www.radiologyinfo.org/sp/info.cfm?pg=obstetricus 

This policy is based on the following evidence-based guidelines: 

1. American College of Obstetrics and Gynecology. (ACOG) Practice Bulletin 

Number 58. Clinical Management Guidelines for Obstetrician-Gynecologist. 

Ultrasonography in Pregnancy. December 2004 



2. American Institute of Ultrasound in Medicine. 3D Technology. Nov 2005. 

Available at: 

http://www.aium.org/publications/statements/_statementSelected.asp?stateme 

nt=23 

3. Hayes Medical Technology Directory. Three-Dimensional and Four-Dimensional 

Ultrasound for Extrafetal and Maternal Structures in Pregnancy. July 2006 

4. Hayes Medical Technology Directory. Three-Dimensional and Four-Dimensional 

Ultrasound for Diagnosis of Fetal Head Abnormalities. Nov 2005 

5. Hayes Medical Technology Directory Three-Dimensional and Four-Dimensional 

Ultrasound for High-Risk Pregnancies and Routine Screening. Nov 2005 

6. American College of Obstetricians and Gynecologists (ACOG), Committee on 

Practice Bulletins. Obstetrics. Ultrasonography in pregnancy. ACOG Practice 

Bulletin No. 101. Washington, DC: ACOG; February 2009. 

References – Update April 2011 

1. Yagel S, Cohen SM, Messing B, Valsky DV. Three-dimensional and fourdimensional 

ultrasound applications in fetal medicine. Curr Opin Obstet Gynecol. 

2009;21(2):167-174. 

2. Chen M, Wang HF, Leung TY, et al. First trimester measurements of nasal bone 

length using three-dimensional ultrasound. Prenat Diagn. 2009;29(8):766-770. 

References – Update July 2009 

1. American College of Obstetricians and Gynecologists (ACOG), Committee on 

Practice Bulletins. Obstetrics. Ultrasonography in pregnancy. ACOG Practice 

Bulletin No. 98. Washington, DC: ACOG; October 2008. 

2. Clinical Practice Obstetrics Committee; Maternal Fetal Medicine Committee, 

Delaney M, Roggensack A, Leduc DC, et al. Guidelines for the management of 

pregnancy at 41+0 to 42+0 weeks. J Obstet Gynaecol Can. 2008;30(9):800- 

823. 

3. Chen M, Lee CP, Lam YH, et al. Comparison of nuchal and detailed morphology 

ultrasound examinations in early pregnancy for fetal structural abnormality 

screening: A randomized controlled trial. Ultrasound Obstet Gynecol. 

2008;31(2):136-146; discussion 146. 

References – Update August 2007 

1. Wang LM, Leung KY, Tang M. Prenatal evaluation of facial clefts by threedimensional 

extended imaging. Prenat Diagn. 2007 May 29; 

2. Lapaire O, Alder J, Peukert R, Holzgreve W, Tercanli S. Two- versus threedimensional 

ultrasound in the second and third trimester of pregnancy: impact 

on recognition and maternal-fetal bonding. A prospective pilot study. Arch 

Gynecol Obstet. 2007 Apr 25. 

3. Goncalves LF, Lee W, Espinoza J, Romero R. Three- and 4-dimensional 

ultrasound in obstetric practice: does it help? J Ultrasound Med. 2005 

Dec;24(12):1599-624. 

4. Towner D, Boe N, Lou K, Gilbert WM. Cervical length measurements in 

pregnancy are longer when measured with three-dimensional transvaginal 

ultrasound. J Matern Fetal Neonatal Med. 2004 Sep;16(3):167-70. 

References 

1. Salim R, Woelfer B, Backos M, et al. Reproducibility of three-dimensional 

ultrasound diagnosis of congenital uterine anomalies. Ultrasound Obstet 

Gynecol 2003; 21(6):578-82 



2. Ghi T. Two-dimensional ultrasound is accurate in the diagnosis of fetal 

craniofacial malformation. Ultrasound Obstet Gynecol 2002; 19(6):543-51 

3. Timor-Tritsch IE, Platt LD. Three-dimensional ultrasound experience in 

obstetrics. Curr Opin Obstet Gynecol 2002; 14(6):569-75 

4. Pooh RK, Pooh K. Transvaginal 3D and Doppler ultrasonography of the fetal 

brain. Semin Perinatol 2001; 25(1):38-43 

5. Kurjak A, Hafner T, Kos M, et al. Three-dimensional sonography in prenatal 

diagnosis: a luxury or a necessity? J Perinat Med 2000; 28(3):194-209 

6. Lai TH, Chang CH, Yu CH, et al. Prenatal diagnosis of alobar holoprosencephaly 

by two-dimensional and three-dimensional ultrasound. Prenat Diagn 2000; 

20(5):400-3 

7. Ayida G, Kennedy S, Barlow D, et al. Contrast sonography for uterine cavity 

assessment: A comparison of conventional two-dimensional with threedimensional 

transvaginal ultrasound: A pilot study. Fertil Steril 1996; 66:848 

8. Baba K, Okai T, Kozuma S, et al: Real-time processable three-dimensional US in 

obstetrics. Radiology 1997; 203:571 

9. Brandl H, Gritzky A, Haizinger M. Three-dimensional ultrasound: A dedicated 

system. Eur Radiol 1999; 9(suppl 3):S331, 

10. Brunner M, Obruca A, Bauer P, et al. Clinical application of volume estimation 

based on three-dimensional ultrasonography. Ultrasound Obstet Gynecol 1995; 

6:358 

11. Chang FM, Hsu KF, Ko HC, et al. Fetal heart volume assessment by threedimensional 

ultrasound. Ultrasound Obstet Gynecol 1997; 9:942 

12. Chang FM, Hsu KF, Ko HC, et al. Three-dimensional ultrasound assessment of 

fetal liver volume in normal pregnancy: A comparison of reproducibility with 

two-dimensional ultrasound and a search for a volume constant. Ultrasound 

Med Biol 1997; 23:381 

13. Downey DB, Fenster A. 3-D US: A maturing technology. Ultrasound Quarterly 

1998;14:25 

14. Feichtinger W. Transvaginal three-dimensional imaging. Fertil Steril 1998; 

70:374 

15. Thomas R, Pretorius N, Pretorius DH. Three-dimensional ultrasound imaging. 

UMB 1998; 24, 1243. 

16. Gilja OH, Hausken T, Berstad A, et al. Measurements of organ volume by 

ultrasonography. Proc Inst Mech Eng 1999; 213:247 

17. Johnson DD, Pretorius DH, Budorick NE, et al. Three-dimesnional ultrasound of 

the fetal lip and primary palate. Radiology 2000; 217:236 

18. Jurkovic D, Geipel A, Gruboeck K, et al. Three-dimensional ultrasound for the 

assessment of uterine anatomy and detection of congenital anomalies: A 

comparison with HSG and two-dimensional sonography. Ultrasound Obstet 

Gynecol 1995; 5:233 

19. Jurkovic D, Gruboeck K, Tailor A, et al. Ultrasound screening for congenital 

uterine anomalies. Br J Obstet Gynaecol 199; 104:1320 

20. Kupesic S, Kurjak A. Diagnosis and treatment outcome of the septate uterus. 

Croat Med J 1998; 39:185, 

21. Lee A, Eppel W, Sam C, et al. Intrauterine device localization by threedimensional 

transvaginal sonography. Ultrasound Obstet Gynecol 1997; 10:289 

22. Lee A, Kratochwil A, Stumpflen I, et al. Fetal lung volume determination by 

three-dimensional ultrasonography. Am J Obstet Gynecol 1996; 175:588 

23. Merz E. Three-dimensional transvaginal ultrasound in gynecological diagnosis. 

Ultrasound Obstet Gynecol 1999; 14:81 



24. Merz E, Weber G, Bahlmann F, et al. Application of transvaginal and abdominal 

three-dimensional ultrasound for the detection or exclusion of malformations of 

the fetal face. Ultrasound Obstet Gynecol 1997; 9:237 

25. Nelson TR, Pretorius DH. Three-dimensional ultrasound imaging. Ultrasound 

Med Biol 1998; 24:1243, 

26. Platt LD, Santulli T, Carlson DE, et al. Three-dimensional ultrasonography in 

obstetrics and gynecology: Preliminary experience. Am J Obstet Gynecol 1998; 

178:1199 

27. Session DR, Daniel SW, Dumesic DA. Three-dimensional ultrasound in 

gynecology. Journal of Gynecologic Techniques 1998; 4:125 

28. Shih JC, Shyu MK, Lee CN, et al. Antenatal depiction of the fetal ear with threedimensional 

ultrasonography. Obstet Gynecol 1998; 91:500 

29. Fenster A, Downey DB. 3-D ultrasound imaging: A review. IEEE Engineering in 

Medicine and Biology 1996; 15:41-51 

30. Fenster A, Tong S, Sherebrin S, et al. Three-dimensional ultrasound imaging. 

SPIE 1995; 2432:176. 

31. Rankin RN, Fenster A, Downey DB, et al. Three-dimensional sonographic 

reconstruction: techniques and diagnostic applications. AJR 1993; 161:695-702. 

32. Sherebrin S, Fenster A, Rankin R, Spence JD. Freehand three-dimensional 

ultrasound: implementation and applications. SPIE Physics of Medical Imaging 

1996; 2708:296-303. 

33. Pretorius DH, Nelson TR. Prenatal visualization of cranial sutures and 

fontanelles with three-dimensional ultrasonography. J Ultrasound Med 13:871- 

876, 1994. 

34. Pretorius DH, Nelson TR. Fetal face visualization using three-dimensional 

ultrasonography. J Ultrasound Med 14:349-356, 1995. 

35. Nelson TR, Pretorius DH. Three-dimensional ultrasound of fetal surface features. 

Ultras Obstet Gynecol 1992; 2:166. 

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Policy Amendment without Notice. 

Health Net reserves the right to amend the Policies without notice to providers or Members. In some 

states, new or revised policies require prior notice or website posting before an amendment is deemed 

effective. 

No Medical Advice. 

The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to 

members. Members should consult with their treating physician in connection with diagnosis and 

treatment decisions. 

No Authorization or Guarantee of Coverage. 

The Policies do not constitute authorization or guarantee of coverage of particular procedure, drug, service 

or supply. Members and providers should refer to the Member contract to determine if exclusions, 

limitations, and dollar caps apply to a particular procedure, drug, service or supply. 

Policy Limitation: Member’s Contract Controls Coverage Determinations. 

The determination of coverage for a particular procedure, drug, service or supply is not based upon the 

Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the 

member’s contract, and requirements of applicable laws and regulations. The contract language contains 

specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, 

eligibility, and other relevant terms and conditions of coverage. In the event the Member’s contract (also 

known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, 

the Member’s contract shall govern. Coverage decisions are the result of the terms and conditions of the 

Member’s benefit contract. The Policies do not replace or amend the Member’s contract. If there is a 

discrepancy between the Policies and the Member’s contract, the Member’s contract shall govern. 

Policy Limitation: Legal and Regulatory Mandates and Requirements. 

The determinations of coverage for a particular procedure, drug, service or supply is subject to applicable 

legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal 

mandates and regulatory requirements, the requirements of law and regulation shall govern. 

Policy Limitations: Medicare and Medicaid. 

Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and 

determining coverage for a particular procedure, drug, service or supply for Medicare or Medicaid 

members shall not be construed to apply to any other Health Net plans and members. The Policies shall 

not be interpreted to limit the benefits afforded Medicare and Medicaid members by law and regulation.

National Medical Policy - Health Net

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