NY Manual
SHP Manual

New York Provider Manual
7.1 Definition of Services | 7.3 Consent Requirements for Hysterectomy - Medicaid, CHPlus and FHPlus

7.2 Diagnostic Testing

All testing, procedures, and consultations related to pregnancy and OB/GYN conditions may be performed or ordered directly by the participating OB/GYN without consulting the PCP, including:

·     Sonograms performed during pregnancy
·     Cervical biopsy
·     Cesarean section
·     Referral to a cardiologist for evaluation of heart murmur/dyspnea during pregnancy
·     Referral to an endocrinologist for evaluation of metabolic disorders during pregnancy 

When a PCP refers a member to the OB/GYN for consultation, the OB/GYN may order or perform certain diagnostic tests. The OB/GYN must communicate all test results to the PCP.

OB/GYN providers should not order tests or consultations for the evaluation of any condition that is not obstetric or gynecological. For example, if a member expresses concern about knee pain during a routine exam and requests referral to an orthopedist, the OB/GYN may not provide such a referral. The member must be referred back to her PCP for follow-up on this condition.