Physician Referral Guidelines for Obstetrics and Gynecology (OBGYN) | Patient Referrals | UC Davis Health

Reason for Referral

• Prenatal diagnosis

Required Medical Records

• All prenatal records
• All prenatal labs
• All prenatal imaging

NOTE:
Please be advised the specialty service line will review and triage referral for appropriate placement in sub departments.

Requested CPT Codes

• 96041 X2 (Commercial)
• S0265 X4 (Medi-Cal)

Reason for Referral

• Maternal Fetal Medicine

Required Medical Records

• All prenatal records
• All prenatal labs
• All prenatal imaging

NOTES:

• Please be advised the specialty service line will review and triage referral for appropriate placement in sub departments.
• No self referrals.

Requested CPT Codes

• Consult Only
• 99202 x 1
• 99203
• 99204
• 99205

Reason for Referral

• Urogynecology

Required Medical Records

• Any relevant records supporting the reason for referral 

NOTE:
Please be advised the specialty service line will review and triage referral for appropriate placement in sub departments.

Requested CPT Codes

• Consult Only
• 99202 x 1
• 99203
• 99204
• 99205

Reason for Referral

• Elective Abortion Less than 14 weeks

Required Medical Records

• Any relevant records supporting the reason for referral 

NOTE:
If any fetal anomalies are identified, please request appropriate CPT codes for genetic testing, provided the patient has not undergone amniocentesis or chorionic villus sampling (CVS) please request 88262,88233,88291,81229. 

Requested CPT Codes

• 99202
• 99203
• 99204
• 99205
• 99215 x2
• 99214 x2
• 99213 x2
• 99212 x2
• 76815
• 76816
• 76817
• 99459
• S0190
• 59840
• 01966
• 36415
• 85027 Modifier TC
• 86900 Modifier TC
• 86901 Modifier TC
• 86850 Modifier TC

Reason for Referral

• Elective Abortion Greater than 14 weeks

Required Medical Records

• Any relevant records supporting the reason for referral 

NOTE:
If any fetal anomalies are identified, please request appropriate CPT codes for genetic testing, provided the patient has not undergone amniocentesis or chorionic villus sampling (CVS) please request 88262,88233,88291,81229. 

Requested CPT Codes

• 99202
• 99203
• 99204
• 99205
• 99215 x2
• 99214 x2
• 99213 x2
• 99212 x2
• 76815
• 76816
• 76817
• 99459
• 59200
• 01966
• 36415
• 85027 Modifier TC
• 86900 Modifier TC
• 86901 Modifier TC
• 86850 Modifier TC

Reason for Referral

• Miscarriage or Early Pregnancy Loss Estimated Gestational Age less than 14 weeks

Required Medical Records

• Any relevant records supporting the reason for referral 

NOTE:
If the patient has not had a chorionic villus sampling (CVS) or amniocentesis performed during this pregnancy, please request the following CPT codes: 88262,88233,88291,81229. 

Requested CPT Codes

• 99202
• 99203
• 99204
• 99205
• 99215 x2
• 99214 x2
• 99213 x2
• 99212 x2
• 76815
• 76816
• 76817
• 99459
• S0190
• 59820
• 01966
• 36415
• 85027 Modifier TC
• 86900 Modifier TC
• 86901 Modifier TC
• 86850 Modifier TC

Reason for Referral

• Fetal Demise EGA greater than 14 weeks

Required Medical Records

• Any relevant records supporting the reason for referral 

NOTE:
If the patient has not had a chorionic villus sampling (CVS) or amniocentesis performed during this pregnancy, please request the following CPT codes: 88262,88233,88291,81229. 

Requested CPT Codes

• 99202
• 99203
• 99204
• 99205
• 99215 x2
• 99214 x2
• 99213 x2
• 99212 x2
• 76815
• 76816
• 76817
• 99459
• 59200
• 59821
• 01966
• 36415
• 85027 Modifier TC
• 86900 Modifier TC
• 86901 Modifier TC
• 86850 Modifier TC

Reason for Referral

• All OBGYN related services

Required Medical Records

• Any relevant records supporting the reason for referral 

Requested CPT Codes

• Consult Only
• 99202 x 1
• 99203
• 99204
• 99205  

Locations Services Provided

• Sacramento