CPT 76820Radiology

Umbilical artery echo

CPT code 76820 covers an ultrasound examination of the umbilical artery, which carries blood from the fetus to the placenta during pregnancy. This test helps doctors check blood flow to ensure the baby is receiving adequate oxygen and nutrients.

Showing rates for

National Average

Base Medicare rate

$42.70

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

0.5

PE RVU (NF)

0.8

MP RVU

0.02

Total RVU

1.32

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

NCCI bundling edits

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Billing tips

Verify 76820 is not already included in comprehensive fetal ultrasound codes (76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76818, 76819) performed on the same date
Impact: Prevents automatic bundling denials; bundling into comprehensive codes can eliminate the separate $42.70 payment entirely
Document the specific clinical indication requiring standalone umbilical artery Doppler separate from routine anatomical ultrasound (e.g., abnormal growth velocity, suspected IUGR, elevated maternal serum markers)
Impact: Reduces medical necessity denials by 65-75% and supports modifier 59 when billed with other ultrasound codes
Include quantitative Doppler measurements (systolic/diastolic ratio, pulsatility index, resistance index) in the report, not just qualitative descriptions
Impact: Essential for medical necessity validation; absence of measurements increases audit risk and can result in $42.70 recoupment
Bill 76820 only when performed as a focused follow-up study; for initial comprehensive fetal assessment, use appropriate comprehensive codes (76805, 76811, etc.) which include umbilical artery evaluation
Impact: Prevents upcoding allegations and maintains compliance; improper use can trigger comprehensive audits of all obstetric ultrasound billing
For serial umbilical artery surveillance in high-risk pregnancies, maintain interval documentation showing clinical changes or protocol-driven monitoring schedules
Impact: Supports multiple studies over weeks/months; inadequate interval justification can lead to frequency limitation denials
When performed in facility settings, ensure both technical and professional components are billed with appropriate modifiers or by separate entities to avoid duplicate billing

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76820 in 2025?

The 2025 Medicare national average payment for CPT 76820 is $42.70 for both facility and non-facility settings. This rate is based on 1.32 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

Can CPT 76820 be billed with a complete fetal ultrasound on the same day?

Generally no, 76820 is bundled into comprehensive fetal ultrasound codes (76805, 76811, 76815, etc.) as umbilical artery assessment is included in complete examinations. Bill 76820 separately only when performed as a distinct, focused follow-up study with separate clinical indication, and append modifier 59 with documentation supporting medical necessity for the separate service.

How often can umbilical artery Doppler (76820) be performed during pregnancy?

There is no specific Medicare frequency limit, but medical necessity must be documented for each study. In high-risk pregnancies with IUGR or placental insufficiency, weekly or even more frequent surveillance may be appropriate. Serial studies require documentation of clinical changes, progressive findings, or established surveillance protocols supported by maternal-fetal medicine guidelines.

What diagnosis codes support medical necessity for CPT 76820?

Common supporting diagnoses include O36.5xxx (maternal care for poor fetal growth/IUGR), O36.8xx (maternal care for other fetal problems), O10-O16 codes (maternal hypertension/preeclampsia), O41.0xxx (oligohydramnios), O36.82x (fetal anemia), and Z36 (encounter for antenatal screening). Documentation must link the specific diagnosis to the clinical need for umbilical artery Doppler assessment.

What are the RVU values for CPT code 76820 in 2025?

CPT 76820 has 0.5 work RVUs, 0.8 practice expense RVUs (both facility and non-facility), and 0.02 malpractice RVUs, totaling 1.32 total RVUs. These are relatively low RVUs reflecting the focused nature of the examination compared to comprehensive obstetrical ultrasound studies.

Do I need a specific modifier when billing 76820 for the professional component only?

Yes, append modifier 26 when billing only the physician interpretation and report component. This applies when the technical component (equipment and sonographer) is provided by a separate facility. The technical component is billed separately with modifier TC. Without modifiers, the code represents the global service including both components.

What measurements must be documented in the report for CPT 76820?

Required documentation includes quantitative Doppler measurements: systolic/diastolic (S/D) ratio, pulsatility index (PI), and/or resistance index (RI). The report must compare values to gestational age-specific norms and provide clinical interpretation. Qualitative descriptions alone (e.g., 'normal flow') are insufficient and may result in denials or audit recoupments.