Abortion Condition Codes

Update To Abortion Condition Codes

Effective October 1, 1998, Medicare does not cover abortions except when the pregnancy is a result of an act of rape or incest; or the woman suffers from a physical disorder, a physical injury or illness, including a life endangering physical condition caused by the pregnancy itself that would (as certified by a physician) place the woman in danger of death unless an abortion is performed.

Beginning July 1, 1999, providers billed for abortion services using Modifier G7 defined as “the pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening.” This modifier is used on claims with Dates of Services October 1, 1998, to the present.

CR7687 announces that (effective October 1, 2002) reason code 32809 is updated with the correct condition codes as follows:

Condition code AA: Abortion Performed due to Rape
Condition code AB: Abortion Performed due to Incest
Condition code AD: Abortion Performed due to life endangering physical condition

Please note that previous condition codes A7 and A8, effective October 1, 2002, are discontinued and reserved for national assignment.

Reference: https://www.cms.gov/MLNMattersArticles/Downloads/MM7687.pdf

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