CPT 76805Radiology

Ob us >= 14 wks sngl fetus

CPT code 76805 covers a complete obstetric ultrasound performed at 14 weeks or later in pregnancy for a woman carrying a single baby. This is the standard anatomy scan that checks fetal development, position, and placental location.

Showing rates for

National Average

Base Medicare rate

$130.03

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)

2.97

MP RVU

0.06

Total RVU

4.02

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

NCCI bundling edits

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Billing tips

Document all required elements for comprehensive exam including fetal presentation, cardiac activity, placental location, amniotic fluid assessment, and complete anatomical survey
Impact: Prevents downcoding to limited exam (76815) which reimburses approximately $50 less
Bill 76805 only once per pregnancy episode unless medically necessary repeat comprehensive exam is performed; routine follow-up scans use 76816
Impact: Medicare and most payers limit 76805 to 1-2 times per pregnancy; additional comprehensive exams without medical necessity face denial
Verify gestational age is 14 weeks or greater with documented LMP or prior ultrasound; exams before 14 weeks require different codes
Impact: Incorrect gestational age coding results in 100% denial; use 76801 for first trimester exams
Do not bill 76805 and 76816 (follow-up) on the same date of service for the same pregnancy
Impact: Bundling edits will deny 76816 as inclusive; results in loss of secondary code reimbursement
Link appropriate ICD-10 diagnosis codes including weeks of gestation (Z3A.XX) and encounter type (Z34.XX for routine prenatal) or specific indication
Impact: Missing gestational age code may trigger payer audits or payment delays; specific indications support medical necessity for multiple exams
When performed in hospital setting, ensure facility bills facility fee and physician bills professional component with modifier 26
Impact: Improper modifier use results in 50% reimbursement loss or complete denial; 2025 professional component approximately $39 vs global $130.03

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76805 in 2025?

The 2025 Medicare national average payment for CPT 76805 is $130.03 for both facility and non-facility settings. This represents 4.02 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement varies by geographic location based on GPCI adjustments.

How many times can you bill 76805 during a pregnancy?

Medicare and most commercial payers allow 76805 to be billed 1-2 times per pregnancy under normal circumstances. Additional comprehensive ultrasounds require documented medical necessity such as suspected fetal anomalies, growth concerns, or maternal complications. Routine follow-up exams should be coded with 76816 instead.

What is the difference between CPT 76805 and 76815?

CPT 76805 is a complete obstetric ultrasound for singleton pregnancy at ≥14 weeks, while 76815 is a limited ultrasound that examines specific fetal anatomy or parameters rather than a comprehensive survey. Code 76805 requires documentation of complete anatomic survey and biometry, whereas 76815 is used for focused evaluations like fetal position, heart rate, or placental location only.

Can CPT 76805 and 76816 be billed together on the same day?

No, CPT 76805 (complete ultrasound) and 76816 (follow-up ultrasound) should not be billed together on the same date of service for the same pregnancy. These codes are mutually exclusive under NCCI edits. Bill only the code that accurately represents the service performed - typically 76805 for the comprehensive anatomy scan and 76816 for subsequent growth or follow-up exams.

What documentation is required to bill CPT code 76805?

Documentation must include gestational age ≥14 weeks, fetal cardiac activity, presentation, placental location and appearance, amniotic fluid volume, complete anatomic survey of all required fetal structures (head, brain, face, heart, spine, abdomen, kidneys, bladder, extremities), biometric measurements (BPD, HC, AC, FL), and physician interpretation with signature. Permanent image storage with patient identification is also required.

What are the work RVUs for CPT 76805 in 2025?

CPT 76805 has 0.99 work RVUs in 2025. The total RVU is 4.02, which includes 0.99 work RVU, 2.97 practice expense RVU (both facility and non-facility), and 0.06 malpractice RVU. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

When should I use modifier 26 with CPT code 76805?

Use modifier 26 with CPT 76805 when billing only the professional component (physician interpretation) in settings where you do not own the ultrasound equipment, such as hospital outpatient departments or imaging centers. The facility separately bills the technical component using modifier TC. In office settings where you own the equipment and provide both components, bill 76805 without modifiers for the global service.