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8.5.4 Transports for Pregnancies
Transporting a pregnant woman may be covered as an emergency transfer if the client's condition is documented as an emergency situation at the time of transfer.
Claims documenting a home delivery or delivery en route are considered emergency transfers. Premature labor and early onset of delivery (less than 37 weeks gestation) also may be considered an emergency. Active labor without more documentation of an emergency situation is not payable as an emergency transport.
First day of last menstrual period (LMP) or estimated date of delivery (EDD) must be in Block 14 of the claim form and on the documentation.
If the pregnant client is transported in an ambulance on a nonemergency basis, all criteria for nonemergency prior authorization must be met.
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