CPT 76813Radiology

Ob us nuchal meas 1 gest

CPT code 76813 is for a specialized ultrasound performed during the first trimester of pregnancy to measure the nuchal translucency (fluid at the back of the baby's neck), which helps screen for chromosomal abnormalities like Down syndrome.

Showing rates for

National Average

Base Medicare rate

$109.98

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

1.18

PE RVU (NF)

2.18

MP RVU

0.04

Total RVU

3.4

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 11+0 to 13+6 weeks based on crown-rump length measurement, not last menstrual period alone
Impact: Examinations outside this window will be denied as not meeting CPT descriptor requirements; results in $109.98 denial
Document FMF or equivalent certification credentials in provider file and attach certification number when required by payer credentialing
Impact: Many commercial payers require proof of NT certification for payment; lack of documentation can result in 100% denial
Do not bill 76813 with standard first-trimester ultrasound 76801 on the same date unless distinct and separately documented examinations with different clinical indications
Impact: 76813 includes standard anatomic survey components; bundling edits will deny one code, typically resulting in loss of $109.98
Ensure images include mandatory views: sagittal view with calipers properly placed on widest NT measurement, neutral fetal neck position documentation, and fetal image occupying at least 75% of screen
Impact: Audits failing to show proper technique result in recoupment; maintain image quality standards to protect against post-payment review
Submit claim promptly after service as some payers have shortened timely filing limits for screening procedures compared to diagnostic codes
Impact: Missing filing deadlines results in 100% claim denial with no appeal rights; typical 90-day window versus 1-year for diagnostic procedures
When billing globally, ensure both technical and professional components are documented; split billing only when services actually performed at separate locations

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76813 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 76813 is $109.98 for both facility and non-facility settings, based on 3.4 total RVUs and the conversion factor of 32.3465.

Can CPT 76813 be billed with a standard first-trimester ultrasound on the same day?

Generally no, CPT 76813 should not be billed with 76801 (first-trimester ultrasound) on the same date as the nuchal translucency measurement includes components of a standard exam. Bill them together only if distinct, separately documented examinations with different clinical indications are performed, using modifier 59.

What credentials are required to bill CPT code 76813?

Providers must have specialized nuchal translucency certification from the Fetal Medicine Foundation (FMF) or equivalent credentialing organization, maintain ongoing quality review with regular image audits, and demonstrate adherence to strict measurement protocols and quality control standards.

What is the acceptable gestational age range for billing 76813?

CPT 76813 requires the examination to be performed between 11 weeks 0 days and 13 weeks 6 days gestation based on crown-rump length measurement. Examinations outside this window should be coded with alternative ultrasound codes such as 76801 or 76805.

How many RVUs is CPT code 76813 worth in 2025?

CPT 76813 has 3.4 total RVUs in 2025, consisting of 1.18 work RVUs, 2.18 practice expense RVUs (both facility and non-facility), and 0.04 malpractice RVUs.

Do commercial insurance plans cover CPT 76813 for nuchal translucency screening?

Coverage varies by payer and plan. Many commercial insurers cover 76813 as part of prenatal screening benefits, but some require prior authorization, specific maternal risk factors, or limit coverage based on maternal age. Always verify benefits and medical necessity criteria before performing the examination.

What documentation is required to support medical necessity for CPT 76813?

Required documentation includes confirmation of gestational age within the 11-14 week window, proper technical images with caliper placement, crown-rump length measurement, provider certification credentials, and clinical indication for first-trimester aneuploidy screening such as maternal request, advanced maternal age, or abnormal serum screening results.