CPT 76801Radiology

Ob us < 14 wks single fetus

CPT code 76801 is an ultrasound examination performed during early pregnancy (before 14 weeks) to evaluate a single fetus. This is typically the first ultrasound in pregnancy to confirm the pregnancy, determine gestational age, and assess fetal viability.

Showing rates for

National Average

Base Medicare rate

$112.89

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.99

PE RVU (NF)

2.45

MP RVU

0.05

Total RVU

3.49

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Verify gestational age is documented as less than 14 weeks 0 days - even one day at 14 weeks or beyond requires code 76805 instead
Impact: Using 76801 beyond 14 weeks results in automatic denials; 76805 reimburses at different rate requiring code change and resubmission
Document single fetus explicitly - if twins or multiples are discovered, you must use 76801 + 76802 (each additional gestation)
Impact: Missing 76802 add-on code for multiple gestations leaves money on the table; 76802 adds additional reimbursement per extra fetus
Ensure interpretation includes all required elements: gestational sac location, crown-rump length measurement, cardiac activity presence/absence, and uterine/adnexal evaluation
Impact: Incomplete documentation can result in downcoding to 76815 (limited OB ultrasound) which pays approximately 30-40% less
Bill global code without modifier when performed in physician office with owned equipment; split 26/TC when equipment is not owned
Impact: Incorrect modifier use can reduce payment by 60-65% if TC billed when global appropriate, or trigger overpayment recovery
Do not bill same-day E/M service without modifier 25 and distinct documentation showing separate medical necessity for the office visit
Impact: E/M without modifier 25 will bundle and deny; proper use with documentation maintains E/M payment averaging $75-150 depending on level
Verify patient benefits cover diagnostic ultrasound before 14 weeks - some payers require specific gestational age minimums or limit number of ultrasounds
Preventable patient balance billing issues; some commercial payers deny as not medically necessary before 6-8 weeks without specific indications

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Frequently asked questions

What is the difference between CPT 76801 and 76805?

CPT 76801 is for ultrasound examination before 14 weeks gestation (first trimester), while 76805 is for examinations at 14 weeks or later. The gestational age at the time of the exam determines which code to use. 76801 focuses on early pregnancy confirmation and dating, while 76805 includes more detailed fetal anatomic survey.

How much does Medicare pay for CPT code 76801 in 2025?

The 2025 Medicare national average payment for CPT 76801 is $112.89 for both facility and non-facility settings. This rate is based on 3.49 total RVUs (0.99 work RVU, 2.45 practice expense RVU, 0.05 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can I bill an E/M visit and 76801 on the same day?

Yes, but the E/M service must be separately identifiable and medically necessary beyond the decision to perform the ultrasound. You must append modifier 25 to the E/M code and ensure documentation clearly shows the E/M service addressed distinct patient concerns or management decisions separate from the ultrasound procedure itself.

What happens if twins are discovered during a 76801 ultrasound?

When multiple gestations are identified, you should bill 76801 for the first fetus and add CPT 76802 for each additional gestation (e.g., 76801 + 76802 for twins, 76801 + 76802 x 2 for triplets). Both codes must be supported by documentation showing each fetus was evaluated.

Is transvaginal ultrasound included in CPT 76801?

Yes, CPT 76801 includes both transabdominal and transvaginal approaches. You should not separately bill for the transvaginal technique - it is considered part of the complete first trimester obstetric ultrasound examination. The approach used should be documented in the report.

What documentation is required to bill CPT 76801?

Required documentation includes gestational age confirmation (<14 weeks), number of fetuses, crown-rump length measurement, fetal cardiac activity assessment, gestational sac location, placental location, uterine and adnexal evaluation, permanent images, and a written physician interpretation. Missing any required element risks denial or downcoding.

When should I use CPT 76815 instead of 76801?

CPT 76815 (limited obstetric ultrasound) is used when performing a focused or limited examination rather than a complete evaluation - such as checking only fetal heart tones, confirming fetal position, or evaluating amniotic fluid volume. If a complete first trimester examination with all required elements is performed before 14 weeks, 76801 is the appropriate code.