CPT 76818Radiology

Fetal biophys profile w/nst

CPT code 76818 covers a fetal biophysical profile with non-stress test (NST), an ultrasound exam that evaluates the well-being of an unborn baby by assessing fetal movement, muscle tone, breathing movements, amniotic fluid volume, and heart rate patterns.

Showing rates for

National Average

Base Medicare rate

$115.15

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

1.05

PE RVU (NF)

2.46

MP RVU

0.05

Total RVU

3.56

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

NCCI bundling edits

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Billing tips

Document all five components separately in the report (fetal breathing, movement, tone, fluid, NST) even if score is zero for some elements
Impact: Missing documentation of any component can trigger denials or downcoding to 76815 (limited ultrasound), losing approximately $40-60 in reimbursement
Ensure NST strip is at least 20 minutes duration and includes interpretation of reactivity in the report
Impact: Inadequate NST documentation may result in denial or request to bill 76815 instead, reducing payment by approximately 30-35%
Use diagnosis codes that support medical necessity for BPP (O36.80X0 for fetal surveillance, O09.XXX for high-risk pregnancy)
Impact: Routine pregnancy codes without high-risk indicators increase denial risk by 40-60% as payers require justification beyond standard prenatal care
Bill 76818 instead of 76819 when NST is performed as part of the biophysical profile
Impact: 76818 ($115.15) includes NST while 76819 (without NST) pays less; incorrect code selection results in underpayment
Verify time documentation when billing with E/M services on same date; ensure BPP interpretation is separate from clinical visit note
Impact: Bundled documentation can trigger modifier 25 denials on E/M code, losing $75-150 in E/M reimbursement
For repeat BPPs same day due to non-reactive NST, append modifier 76 and document change in clinical status or need for extended monitoring
Impact: Without proper modifier and documentation, second BPP will deny as duplicate; proper billing captures additional $57-86 (typically 50-75% of allowed amount)

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Frequently asked questions

What is the difference between CPT 76818 and 76819?

CPT 76818 includes a non-stress test (NST) as the fifth component of the biophysical profile, while 76819 is a biophysical profile without NST (only four ultrasound components). 76818 reimburses at $115.15 for 2025 Medicare and includes evaluation of fetal heart rate reactivity. Use 76818 when NST is performed as part of the BPP.

How much does Medicare pay for CPT code 76818 in 2025?

Medicare pays $115.15 for CPT 76818 in 2025 based on the national average non-facility rate. This is calculated from 3.56 total RVUs (1.05 work RVU + 2.46 practice expense RVU + 0.05 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

Can you bill an E/M visit and 76818 on the same day?

Yes, you can bill an E/M service and 76818 on the same day if both services are medically necessary and separately documented. Append modifier 25 to the E/M code to indicate a significant, separately identifiable evaluation and management service. The E/M documentation must be distinct from the BPP interpretation and address other aspects of patient care.

What diagnosis codes support medical necessity for 76818?

Diagnosis codes that support 76818 include high-risk pregnancy codes (O09.XX), fetal growth concerns (O36.5XX0), decreased fetal movements (O36.81X0), oligohydramnios (O41.00X0), maternal diabetes (O24.XXX), hypertension (O10.XXX-O16.XXX), and post-term pregnancy (O48.0). Routine pregnancy codes (Z34.XX) typically do not support medical necessity without additional high-risk factors documented.

How often can you bill CPT 76818 during a pregnancy?

There is no absolute Medicare frequency limit for 76818, but frequency must be medically justified based on specific high-risk conditions. Common protocols include twice-weekly BPPs for insulin-dependent diabetes or post-term pregnancies, and weekly BPPs for moderate-risk conditions. Each claim must document the continuing medical necessity, and excessive frequency without clinical justification will trigger denials or audits.

What are the RVUs for CPT code 76818?

CPT 76818 has 3.56 total RVUs for 2025, consisting of 1.05 work RVUs, 2.46 non-facility practice expense RVUs, 2.46 facility practice expense RVUs, and 0.05 malpractice RVUs. These values are from the CMS Physician Fee Schedule RVU25A released December 23, 2024.

Do you need all five components documented to bill 76818?

Yes, complete documentation of all five components is required to bill 76818: fetal breathing movements, gross body movements, fetal tone, amniotic fluid volume, and non-stress test with reactivity interpretation. Each component must be explicitly scored (0 or 2 points). If any component is missing or not documented, the service may be downcoded to 76815 (limited ultrasound) or denied entirely.