Can you get a pregnancy ultrasound without a doctor’s referral?

Two kinds of pregnancy ultrasound

The machines can look much the same. The jobs are different.

A medical (diagnostic) ultrasound is ordered for a reason. In the first trimester, those reasons are listed in a practice guideline written jointly by the American College of Radiology, ACOG, the Society for Maternal-Fetal Medicine and two ultrasound societies. They include confirming the pregnancy is in the uterus, confirming a heartbeat, estimating how far along you are, checking for twins or more, and looking into pain, bleeding or a suspected ectopic pregnancy (ACR–ACOG–AIUM–SMFM–SRU practice parameter). A physician reads the images, and a report goes to the clinician who ordered them. Insurance usually pays, because it’s medical care.

An elective (keepsake) ultrasound is one you book to see your baby. Nobody orders it, insurance doesn’t pay for it, and it isn’t a medical exam. At a good studio it’s done by an experienced sonographer, but it doesn’t screen for problems, set your due date, or stand in for any visit with your doctor or midwife.

The two can work together: an elective scan to see it, and a medical one to date it and check on your health.

Do you need a referral?

For an elective scan, no. You call or book online, and you pay the studio.

For a medical scan, almost always. Hospital imaging departments schedule diagnostic ultrasounds from a clinician’s order and send the results back to that clinician. “Ultrasounds require a physician order,” one hospital system’s scheduling page says (Deaconess Health System), and others, such as UCLA Health, ask for your doctor’s order before booking (UCLA Health). In U.S. hospitals it’s also a federal rule: radiologic services “must be provided only on the order of practitioners” who are authorized to order them (42 CFR 482.26). Either way, the road to a medical scan runs through a doctor, midwife or nurse practitioner first.

The exception is an emergency. If you have severe pain, heavy bleeding or feel faint, the emergency room will see you without a referral, and that’s where you should go.

Where people get an early scan

First, check that elective scans are allowed where you live. Connecticut law requires an obstetric ultrasound to be for a medical or diagnostic purpose and ordered by a licensed provider (AuntMinnie). Germany has banned non-medical ultrasound in pregnancy since January 2021 (Deutsches Ärzteblatt). The practice guideline also warns that keepsake scanning without a physician’s order may break state laws or regulations (ACR–ACOG–AIUM–SMFM–SRU).

Where they are allowed, the routes look roughly like this.

• Your doctor or midwife. The standard route. Many practices book the first visit at about 8 to 10 weeks, and see you sooner if you have symptoms or a history that calls for it. Why your first prenatal appointment isn’t until 8 to 12 weeks explains the wait.
• Your fertility clinic. After IVF, early scans usually happen there before your care moves to a doctor or midwife.
• The emergency room. For severe pain, heavy bleeding, shoulder-tip pain or feeling faint. For milder symptoms, call your doctor or midwife first. Not for a first look when you feel well.
• An elective ultrasound studio. No referral and no insurance, often within days. It shows you the pregnancy and gives you pictures, and it doesn’t do the medical job.

Lots of people use more than one. A doctor at Jefferson Health in Philadelphia surveyed her patients. Close to half had already had an ultrasound somewhere before their first prenatal visit, and about a quarter had been to an emergency room (NPR, via Michigan Public).

What each one costs

Prices vary widely, so treat these as rough ranges rather than quotes. How much does an early pregnancy ultrasound cost without insurance? goes further, with ways to get a written price before you go.

• A medical ultrasound without insurance. GoodRx puts the national average for an ultrasound at about $400, with a range of $200 to $1,000, and a routine fetal ultrasound at about $459. For a fetal scan in California it gives a rough range of $180 to $800 (GoodRx).
• A medical ultrasound with insurance. Usually covered when it’s medically necessary. Check your plan for a copay or deductible.
• An elective early scan. Each studio sets its own price, paid out of pocket. Ours, the Pregnancy Check, is $100, including 8 black-and-white prints, and if it’s too early to see, the second look is almost always at no charge.

If you live in California, are pregnant and not on Medi-Cal, and your household income is under the limit, ask a participating provider (DHCS lists them) about presumptive eligibility. It gives you immediate, temporary Medi-Cal for outpatient prenatal care while your full application is decided (California DHCS). It’s worth doing even if you also book an elective scan, because it covers the care that matters most.

Elsewhere in the U.S., or if Medi-Cal isn’t an option, call a community health center. They see patients with or without insurance and charge on a sliding fee scale based on income (HRSA). Ask whether they offer prenatal care, and how soon they can see you. Outside the U.S., start with your family doctor, a midwife or your local health service.

What the FDA and medical societies say about keepsake scans

You should hear this from a studio before you book, not find it afterwards.

The FDA says ultrasound can slightly heat tissue and, in some cases, form tiny pockets of gas, and that the long-term effects are still unknown. It says scanning purely for non-medical reasons, such as keepsake videos, has been discouraged, and that keepsake images are reasonable when they come from an exam that was medically needed and need no extra scanning. It also says fetal heartbeat monitors should be used only by trained providers, when medically necessary (FDA).

The American Institute of Ultrasound in Medicine (AIUM) goes further. It “strongly discourages the nonmedical use of ultrasound,” names commercial keepsake studios among the uses it doesn’t support, and wants every fetal scan done by credentialed professionals using the lowest exposure needed (AIUM). Inteleos, the organization behind the main sonography credentials, says it doesn’t endorse ultrasound for non-diagnostic purposes (Inteleos).

We don’t hide that. A Pregnancy Check takes a few minutes, and we never present a visit as a health check. Safety, in plain words has the full statements. Whether an elective scan is right for you is your decision, and your doctor or midwife is a good person to talk it over with. Is an early ultrasound safe for the baby? goes through the evidence.

Questions to ask before you book a private scan

If you decide to go, these questions separate a careful studio from a casual one. A good studio will answer every one of them without fuss.

• Who will scan me, and what training do they have? Ask about experience and credentials. The RDMS (Registered Diagnostic Medical Sonographer) credential from ARDMS requires passing a physics exam and a specialty exam, such as OB/GYN (ARDMS).
• What kind of scan is it, and how long does it take? For an early pregnancy, a short 2D scan is what shows the most. 3D and 4D come later in pregnancy.
• What happens if it’s too early to see? Ask whether a second look is included and whether it costs extra.
• What do I take home? Prints, digital images, or both, and how many.
• Who can come with me? A partner, your mom, your kids, a friend on a video call.
• What happens if something looks unusual? A studio can’t diagnose, so ask how they’d tell you and where they’d send you.
• Is it private? A room of your own, by appointment.
• What’s the total price? One price, or a base price with add-ons.

Red flags to walk away from

Most studios are careful. A few aren’t, and these are the signs.

• A promise that everything looks fine. No elective studio can check on your baby’s health. One that offers to is claiming a job it can’t do.
• A medical-looking report. Measurements and “findings” from a keepsake scan can cause real worry, or false comfort, with no doctor to explain them. Your due date and any health questions belong with your doctor or midwife.
• Boy or girl at 8 or 10 weeks, by ultrasound. A scan can’t show it that early. We don’t book gender scans before 13 weeks, and we’re surest from 15. When you can find out, and how.
• Long 3D or 4D sessions in the first trimester. The FDA and AIUM both ask for the lowest exposure needed, and in early pregnancy a short 2D scan shows the most anyway.
• No clear answer about who scans. If a studio can’t tell you who will hold the probe and what experience they have, keep looking.
• Pressure to upgrade. An early look needs a short scan and a few pictures. It doesn’t need a package.

How it works at our studio

Our Pregnancy Check is a short, private 2D ultrasound in the first 10 weeks. It’s not a doctor’s office: there’s no referral and no insurance form. Same-day appointments are often available.

1. Call us. Tell us the first day of your last period, or how far along you think you are. If it’s too soon to see anything, we’ll say so and suggest a better day.
2. Come in. 1160 N. Central Ave., Suite 207, Glendale. Second floor, with free parking. Bring whoever you like, or no one.
3. Watch the big screen. It’s a 2D ultrasound, and it takes a few minutes. We point out what you’re looking at, so the picture makes sense.
4. Take your pictures home. 8 black-and-white prints.
5. Too early to see? Come back. The second look is almost always free.

Irina, our lead sonographer, has nearly two decades of experience and more than 30,000 pregnancy ultrasounds behind her, and we’ve been in Glendale since 2006. A Pregnancy Check is $100. Call (818) 243-7010; we’re open Mon–Sat 10am–5pm and Sun 10am–3pm, by appointment. More about the Pregnancy Check, or all sessions and prices.

You still need prenatal care

Whatever you decide about an elective scan, book your first prenatal appointment. Your doctor or midwife dates the pregnancy, runs the first labs, and talks you through the screening tests that come later in the first trimester. We can’t do any of that, and a visit with us never replaces it.

If you’re still deciding whether an early look is worth it, Is an early reassurance scan worth it? weighs it up. To pick a day that’s worth the trip, read How early can an ultrasound see a pregnancy? and When can you see the heartbeat on an ultrasound?.

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