The anatomy scan is generally covered by health insurance as part of prenatal care, but how much you pay out of pocket depends on your specific plan type. Most employer-sponsored plans, Marketplace plans, and Medicaid programs include at least one mid-pregnancy ultrasound as a covered benefit. The key variable is whether your plan treats it as a preventive service (no cost to you) or as a diagnostic service that applies to your deductible first.
How the ACA Affects Coverage
The Affordable Care Act requires all Marketplace plans and most employer plans to cover preventive services for women without charging a copay or coinsurance, even before you meet your deductible. Prenatal care falls under this umbrella. However, not every insurer classifies the anatomy scan itself as “preventive.” Some plans bundle all prenatal ultrasounds into the preventive category, while others treat the anatomy scan as a diagnostic imaging service, which means standard cost-sharing rules apply.
This distinction matters a lot for your bill. If your plan considers the anatomy scan preventive, you owe nothing. If it’s classified as diagnostic, you’ll likely pay a portion based on your deductible and coinsurance structure. The only reliable way to find out is to call the member services number on the back of your insurance card and ask specifically how a prenatal ultrasound is coded and categorized under your plan.
What Medicaid Covers
Every state Medicaid program covers prenatal ultrasounds, but many states place limits on how many you can get. Most states allow two or three ultrasounds per pregnancy, with additional scans approved only when medically necessary. A few states are stricter: Indiana does not cover routine ultrasounds or ultrasounds for sex determination, and West Virginia covers ultrasounds only for high-risk pregnancies based on criteria from the American College of Obstetricians and Gynecologists. If your pregnancy is otherwise uncomplicated and you’re in a state with quantity limits, your anatomy scan will typically count as one of your allowed scans.
Why You Might Get Two Separate Bills
One thing that catches people off guard is receiving two charges for a single anatomy scan. That’s because ultrasound services are billed in two parts: a technical component and a professional component. The technical fee covers the equipment, the room, and the sonographer who performs the scan. The professional fee covers the radiologist or maternal-fetal medicine specialist who reads the images and writes the interpretation report.
If you have your scan at a hospital-based imaging center, these two fees often come from different billing departments, and they may even show up as separate line items on your explanation of benefits. An independent imaging center or your OB’s office may bill them together as a single charge, which tends to result in a lower total cost. If cost is a concern and your provider gives you a choice of locations, it’s worth asking about the price difference.
High-Deductible Plans and HSA Eligibility
High-deductible health plans (HDHPs) cover preventive care before the deductible, including certain prenatal services. But as with other plan types, the anatomy scan may or may not fall into the preventive bucket. If your HDHP treats it as a diagnostic service, you’ll pay the full negotiated rate until you hit your deductible, then split costs through coinsurance until you reach your out-of-pocket maximum.
The good news is that any out-of-pocket costs for the anatomy scan are eligible expenses for a Health Savings Account or Flexible Spending Account. The IRS considers prenatal diagnostic imaging a qualified medical expense, so you can use pre-tax dollars from your HSA or FSA to cover your share. If you know you have a scan coming up and haven’t maxed out your FSA contributions for the year, this is a straightforward way to reduce the effective cost.
How Billing Codes Affect Your Coverage
Not all anatomy scans are billed the same way, and the code your provider uses can change what your insurance approves. The standard anatomy scan, used for routine screening in uncomplicated pregnancies, checks the number of fetuses, examines the brain, spine, abdomen, and heart (specifically a four-chamber view), assesses amniotic fluid, and evaluates the umbilical cord insertion site. This is the scan most pregnant people receive around 18 to 22 weeks.
A more detailed version exists for pregnancies with known or suspected fetal abnormalities, a history of a previous anomalous pregnancy, advanced maternal age, diabetes, or an abnormal prenatal screening result. This detailed scan includes everything in the standard version plus a more thorough anatomical survey. According to the Society for Maternal-Fetal Medicine, this detailed scan “is not intended to be the routine scan performed for all pregnancies” and is expected to be rare outside of referral practices that specialize in fetal anomalies. Only one per pregnancy, per practice, is considered appropriate.
Why does this matter for your bill? If your provider bills the detailed code for a routine pregnancy without a documented medical reason, your insurer may deny the claim or require you to pay more. If you’re told you need the more detailed scan, make sure your provider documents the medical indication so it’s clearly justified for insurance purposes.
Follow-Up Scans and Repeat Visits
Sometimes the baby’s position during the anatomy scan makes it impossible to get all the necessary views. If the sonographer can’t adequately image the heart or spine because the baby is curled up or facing the wrong direction, your provider will typically schedule a follow-up. These follow-up scans are billed under a different, less expensive code meant for focused reassessment of specific structures. Most insurers cover them when ordered by your provider, since completing the anatomy evaluation is a standard part of prenatal care. Still, a follow-up counts as a separate visit, so if your plan applies cost-sharing, you may owe a second round of copay or coinsurance.
3D and 4D Scans Are Not Covered
If you’re hoping insurance will pay for a 3D or 4D ultrasound, it almost certainly won’t. Insurers consider these scans investigational rather than medically necessary. Standard 2D imaging remains the primary diagnostic tool for evaluating fetal anatomy, and the clinical advantage of 3D imaging hasn’t been established clearly enough to justify routine coverage. The FDA has also specifically discouraged the use of ultrasound for non-medical purposes like keepsake videos. Boutique ultrasound studios that offer “bonding” sessions with 3D or 4D images are entirely out-of-pocket expenses and not eligible for insurance reimbursement.
How to Reduce Your Out-of-Pocket Cost
Before your anatomy scan appointment, take a few steps to avoid surprise bills. First, confirm with your insurer whether prenatal ultrasounds are classified as preventive or diagnostic under your specific plan. Second, ask whether the imaging facility is in-network. Out-of-network scans can cost several times more. Third, if you have a choice between a hospital-based imaging center and your OB’s office or a freestanding imaging center, compare prices. Hospital-based facilities frequently charge higher facility fees.
If you’re uninsured or your plan has high cost-sharing, ask the imaging facility about self-pay rates. Many facilities offer a discounted cash price that’s significantly lower than what they bill insurance. A standard anatomy scan at an independent imaging center typically costs less than one performed at a hospital outpatient department, sometimes by hundreds of dollars.