1. (1) Home uterine monitoring (S9001) requires prior authorization (PA) and may be approved for the following conditions:

   1. (a) Pre-term labor with one or more of the following complications:

      1. (A) Incompetent cervix;
      2. (B) Cervical cerclage;
      3. (C) Polyhydramnios;
      4. (D) Anomalies of the uterus;
      5. (E) History of cone biopsy;
      6. (F) Cervical dilation or effacement;
      7. (G) Unknown etiology.
   2. (b) History of pre-term labor and delivery;
   3. (c) Multiple gestation.
2. (2) Uterine monitoring will only be approved for the above conditions between the 24th and through the completion of the 36th week of pregnancy.
3. (3) The Division will provide coverage for rental only. The allowable rental fee for the uterine monitor includes all equipment, supplies, services, and nursing visits necessary for the effective use of the monitor. This does not include medications or prescribing practitioner’s professional services.
4. (4) The client must have landline telephone or reasonable access to one. The Division will not be responsible for providing the landline telephone or landline access.

Statutory/Other Authority

ORS 413.042 & 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 61-2014, f. 10-3-14, cert. ef. 10-7-14
OMAP 44-2004, f. & cert. ef. 7-1-04
OMAP 32-2001, f. 9-24-01, cert. ef. 10-1-01
OMAP 37-2000, f. 9-29-00, cert. ef. 10-1-00
OMAP 1-2000, f. 3-31-00, cert. ef. 4-1-00
OMAP 13-1999, f. & cert. ef. 4-1-99
OMAP 11-1998, f. & cert. ef. 4-1-98
HR 17-1996, f. & cert. ef. 8-1-96
HR 41-1994, f. 12-30-94, cert. ef. 1-1-95
HR 9-1993, f. & cert. ef. 4-1-93
HR 10-1992, f. & cert. ef. 4-1-92
HR 13-1991, f. & cert. ef. 3-1-91