CPT 76819Radiology

Fetal biophys profil w/o nst

CPT code 76819 covers a fetal biophysical profile ultrasound that evaluates the health and well-being of an unborn baby by checking specific physical activities and measurements, but does not include a non-stress test (NST) of the baby's heart rate.

Showing rates for

National Average

Base Medicare rate

$83.13

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

0.77

PE RVU (NF)

1.76

MP RVU

0.04

Total RVU

2.57

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

NCCI bundling edits

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Billing tips

Document all four biophysical profile components separately (fetal breathing, body movement, tone, amniotic fluid volume) with specific observations and scoring for each
Impact: Prevents denials for incomplete documentation; missing even one component can result in 100% claim denial or downcoding to a basic ultrasound (approximately $60-70 loss per claim)
Ensure that 76819 is billed only when NST is NOT performed; if NST is included, bill 76818 instead
Impact: Incorrect code selection between 76818 and 76819 is a top denial reason; using the wrong code can delay payment by 30-45 days during reprocessing
Verify medical necessity with appropriate ICD-10 codes indicating high-risk pregnancy factors (O09.x codes, O36.x codes for maternal care related to fetal problems)
Impact: Medicare and most commercial payers deny 76819 without documented high-risk indications; proper diagnosis coding increases first-pass claim acceptance rate by approximately 25%
Bill global service (no modifier) when your facility owns equipment and provides both technical and professional components; split bill with 26/TC when components are separate
Impact: Incorrect modifier use can result in 40-60% underpayment; global rate is $83.13 versus separate component billing which varies by payer
Do not bill 76819 on the same date as 76805 or 76816 without modifier 59 and strong documentation of medical necessity for separate procedures
Impact: NCCI edits bundle these codes; billing together without proper modifier results in automatic denial of the secondary procedure (potential $83.13 loss)
Maintain ultrasound images and biophysical scoring sheets for minimum 7 years as these are frequently requested during audits

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Frequently asked questions

What is the difference between CPT 76818 and 76819?

CPT 76818 includes a complete fetal biophysical profile WITH non-stress testing (NST), meaning it includes both the ultrasound assessment of four biophysical components plus fetal heart rate monitoring. CPT 76819 includes only the ultrasound biophysical profile WITHOUT the non-stress test. You must select the code based on whether NST was actually performed and documented. These codes are mutually exclusive and cannot be billed together on the same date.

What is the Medicare reimbursement rate for CPT 76819 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 76819 is $83.13 for both facility and non-facility settings. This is based on a total RVU of 2.57 (Work RVU: 0.77, PE RVU: 1.76, MP RVU: 0.04) multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary based on geographic locality adjustments.

How many RVUs is CPT code 76819 worth?

CPT code 76819 has a total RVU value of 2.57 for 2025, consisting of 0.77 work RVUs, 1.76 practice expense RVUs (both facility and non-facility), and 0.04 malpractice RVUs according to the CMS Medicare Physician Fee Schedule RVU25A.

Can CPT 76819 be billed with a comprehensive obstetric ultrasound on the same day?

Generally no, unless there is distinct medical necessity and separate documentation for each procedure. NCCI edits typically bundle 76819 with comprehensive obstetrical ultrasounds (76805, 76811, 76816). If both are medically necessary and separately identifiable, modifier 59 or XU may be appended to 76819, but you must document different clinical indications, separate physician orders, and maintain distinct documentation for each examination to withstand audit.

What diagnosis codes support medical necessity for CPT 76819?

Appropriate ICD-10 codes include high-risk pregnancy indicators such as O09.x codes (supervision of high-risk pregnancy), O24.x (diabetes in pregnancy), O10.x-O16.x (hypertensive disorders), O36.x codes (maternal care for fetal problems including decreased movement, poor growth, or other complications), O48.x (post-term pregnancy), and specific maternal conditions requiring enhanced fetal surveillance. Routine prenatal care codes without high-risk factors typically result in denial.

What are the four components of a fetal biophysical profile for CPT 76819?

The four ultrasound components are: (1) fetal breathing movements (one or more episodes of rhythmic breathing lasting 30+ seconds within 30-minute observation), (2) gross body movements (three or more discrete movements), (3) fetal tone (one or more episodes of active extension with return to flexion of limbs or trunk), and (4) amniotic fluid volume (single deepest pocket >2cm or AFI >5cm). Each component receives 0 or 2 points for a maximum score of 8. Note that 76819 does NOT include the fifth component (NST), which would make it 76818.

Who can perform and bill for CPT code 76819?

CPT 76819 can be billed by physicians specializing in Obstetrics and Gynecology, Maternal-Fetal Medicine, or Radiology with obstetrical ultrasound expertise. Sonographers may perform the technical component under appropriate physician supervision, but a qualified physician must provide the interpretation and report. When billing is split, the facility bills the technical component (modifier TC) and the interpreting physician bills the professional component (modifier 26). For global billing, the same entity must provide both components.