Low-Risk Pregnancy Exemption

Prescriptions can be written by your physician, by a free clinic, or by the hospital. It must always specify “pregnancy” and include the date of last period.

Each prescription may contain up to 8 tests. 

WITHIN THE 13^TH WEEK

• 90622 COMPLETE BLOOD COUNT
• 90092 ASPARTATE AMINOTRANSFERASE (AST)
• 90045 ALANINE AMINOTRANSFERASE (ALT)
• 91264G RUBELLA IGG ANTIBODIES
• 91264M RUBELLA IGM ANTIBODIES
• 91094G TOXOPLASMA IGG ANTIBODIES
• 91094M TOXOPLASMA IGM ANTIBODIES
• 91105 TREPONEMA PALLIDUM ANTIBODIES
• 91111 VDRL (VENEREAL DISEASE RESEARCH LABORATORY TEST)
• 91224 HIV
• 90271 BLOOD SUGAR 
• 90443 URINALYSIS
• 90493 INDIRECT COOMBS TEST
• 90653 BLOOD GROUP ABO AND RH (only in a hospital structure)

A patient who hasn’t undergone a first check-up before the 13th week may still take first trimester test as long as their doctor fills in a prescription with the exemption code M99 specifying: pregnancy, date of last period, and “first pregnancy check-up”

For Thalassemia screening during a low-risk pregnancy click here

BETWEEN 14^TH AND 18^TH WEEK

• 90443 URINALYSIS
• 90942 URINE CULTURE (please specify “significant bacteriuria”)
• 91094G TOXOPLASMA IGG ANTIBODIES (please specify “previous toxo negative”)
• 91094M TOXOPLASMA IGM ANTIBODIES (please specify “previous toxo negative”)

BETWEEN 19^TH AND 23^RD WEEK

• 90443 URINALYSIS
• 90942 URINE CULTURE (please specify “Significant Bacteriuria”)
• 91094G TOXOPLASMA IGG ANTIBODIES (please specify “previous toxo negative”)
• 91094M TOXOPLASMA IGM ANTIBODIES (please specify “previous toxo negative”)
• 90493 INDIRECT COOMBS TEST (only when Rh is negative)

BETWEEN 24^TH AND 27^TH WEEK

• 90271SP BLOOD SUGAR
• 90443 URINALYSIS
• 90942 URINE CULTURE (please specify “Significant Bacteriuria”)
• 91094G TOXOPLASMA IGG ANTIBODIES (please specify “previous toxo negative”)
• 91094M TOXOPLASMA IGM ANTIBODIES (please specify “previous toxo negative”)

BETWEEN 28^TH AND 32^ND WEEK

• 90622 COMPLETE BLOOD COUNT
• 90223 FERRITIN BLOOD TEST
• 90443 URINALYSIS
• 90942 URINE CULTURE (please specify “Significant Bacteriuria”)
• 91094G TOXOPLASMA IGG ANTIBODIES (please specify “previous toxo negative”)
• 91094M TOXOPLASMA IGM ANTIBODIES (please specify “previous toxo negative”)
• 90493 INDIRECT COOMBS TEST (only when Rh is negative)

BETWEEN 33^RD AND 37^TH WEEK

• 91185 HBSAG (HEPATITIS B SURFACE ANTIGEN)
• 91195 HCV (HEPATITIS C VIRUS)
• 91224 HIV
• 90622 COMPLETE BLOOD COUNT
• 90443 URINALYSIS
• 90942 URINE CULTURE (please specify “Significant Bacteriuria”)
• 91094G TOXOPLASMA IGG ANTIBODIES (please specify “previous toxo negative”)
• 91094M TOXOPLASMA IGM ANTIBODIES (please specify “previous toxo negative”)
• 90493 INDIRECT COOMBS TEST (only when Rh is negative)

BETWEEN 38^TH AND 40^TH WEEK

• 90443 URINALYSIS
• 90942 URINE CULTURE (please specify “Significant Bacteriuria”)
• 91094G TOXOPLASMA IGG ANTIBODIES (please specify “previous toxo negative”)
• 91094M TOXOPLASMA IGM ANTIBODIES (please specify “previous toxo negative”)
• 90493 INDIRECT COOMBS TEST (only when Rh is negative)