CPT 76825Radiology

Echo exam of fetal heart

CPT code 76825 covers a specialized ultrasound examination of an unborn baby's heart to check for structural defects or abnormalities. This is typically ordered when there's an increased risk of congenital heart disease.

Showing rates for

National Average

Base Medicare rate

$248.10

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

1.67

PE RVU (NF)

5.93

MP RVU

0.07

Total RVU

7.67

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify that documentation includes all required cardiac structures (four chambers, valves, great vessels, connections, rhythm assessment) to support complete fetal echo vs. limited cardiac views
Impact: Prevents downcoding to 76827 or 76828 which reimburse significantly less; maintains full $248.10 Medicare payment
Bill 76825 separately from routine obstetric ultrasounds (76811, 76812, 76815, 76816) when medical necessity is documented and distinct cardiac indication exists
Impact: Ensures separate reimbursement of $248.10 in addition to routine OB ultrasound payment when properly documented
Document the specific indication for fetal echocardiography (family history, maternal condition, abnormal screening, suspected anomaly) to establish medical necessity
Impact: Reduces denial rate by 60-70% when clear indication is documented; many payers deny without documented risk factors
For facility billing, ensure proper split between professional (26) and technical (TC) components based on employment structure and equipment ownership
Impact: Proper component billing prevents duplicate payment issues and compliance risks
Check payer-specific policies on gestational age limitations; some commercial payers restrict coverage to 18-24 weeks without prior authorization
Impact: Obtaining prior authorization for exams outside typical window prevents denials averaging $248 per claim
When billing for follow-up fetal echocardiograms in same pregnancy, document interval changes or new findings that justify repeat examination
Supports medical necessity for multiple exams; prevents frequency limitation denials that can affect 30-40% of repeat studies

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 76825?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Common denials

Lack of documented medical necessity or specific indication for fetal echocardiography beyond routine prenatal screening

How to appeal: Submit appeal with detailed clinical documentation highlighting specific risk factors (family history of CHD, maternal diabetes, suspected anomaly on screening ultrasound, exposure to teratogens). Include relevant maternal and fetal history supporting need for specialized cardiac evaluation beyond routine anatomy scan. Reference clinical guidelines from American Institute of Ultrasound in Medicine (AIUM) or American Society of Echocardiography (ASE) supporting indication.

Bundling denial when billed same day as comprehensive obstetric ultrasound (76805, 76811, 76812) without distinct indication

How to appeal: Provide documentation showing fetal echocardiogram was performed as separate, medically necessary service with distinct cardiac indication beyond routine anatomic survey. Append modifier 59 to 76825 and submit operative reports showing separate cardiac-focused examination with comprehensive evaluation of cardiac structures not fully assessed during routine OB ultrasound.

Frequency limitation denial for multiple fetal echocardiograms during same pregnancy

How to appeal: Document clinical justification for repeat examination such as: progression of known anomaly, inadequate visualization on prior exam due to fetal position, new maternal or fetal findings requiring reassessment, or gestational age-specific evaluation (early vs. late gestation). Include comparison with prior study results and explanation of how repeat exam changed clinical management.

Denial for missing or incomplete documentation of required cardiac structures and measurements in interpretation report

How to appeal: Submit complete fetal echocardiography report documenting all required elements: four-chamber view, ventricular outflow tracts, three-vessel view, aortic and ductal arches, atrial and ventricular septae, atrioventricular and semilunar valves, cardiac position and axis, rhythm assessment, and functional assessment. Include representative images and measurements with interpretation by qualified physician with fetal echo expertise.

Frequently asked questions

What is the Medicare reimbursement rate for CPT 76825 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 76825 is $248.10 for both facility and non-facility settings. This is based on 7.67 total RVUs (1.67 work RVU, 5.93 practice expense RVU, 0.07 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on regional adjustments.

Can CPT 76825 be billed with a routine prenatal ultrasound on the same day?

Yes, CPT 76825 can be billed separately from routine obstetric ultrasounds (76805, 76811, 76812, 76815, 76816) when there is a distinct medical indication for specialized fetal cardiac evaluation beyond the cardiac views included in a routine anatomy scan. Documentation must clearly establish medical necessity for the fetal echocardiogram (such as family history of congenital heart disease, maternal diabetes, or suspected cardiac anomaly), and modifier 59 should be appended to 76825 to indicate it is a distinct procedural service.

What is the difference between CPT 76825 and 76827 for fetal heart evaluation?

CPT 76825 represents a complete fetal echocardiogram with comprehensive evaluation of all cardiac structures, chambers, valves, connections, and function. CPT 76827 is a follow-up or repeat study performed to re-evaluate a previously identified cardiac abnormality. Code 76827 reimburses at a lower rate because it focuses on assessing progression or resolution of known findings rather than performing a complete initial cardiac evaluation. Using 76825 for follow-up studies without documenting complete re-evaluation can result in audits and recoupment.

How many times can CPT 76825 be billed during a single pregnancy?

There is no absolute Medicare limit on the number of times CPT 76825 can be billed during a pregnancy, but each examination must be medically necessary and documented accordingly. Typical scenarios supporting multiple fetal echocardiograms include: initial diagnosis of cardiac anomaly with follow-up to assess progression, inadequate initial study due to fetal position requiring repeat exam, early screening in high-risk patient with later confirmation study, or new findings requiring reassessment. Many commercial payers limit coverage to 1-2 exams per pregnancy without prior authorization, so verify specific payer policies.

Who is qualified to perform and interpret CPT 76825 fetal echocardiograms?

CPT 76825 should be interpreted by a physician with specialized training in fetal echocardiography, typically maternal-fetal medicine specialists or pediatric cardiologists with fetal imaging expertise. The technical component can be performed by registered sonographers with fetal echocardiography training (RDCS or RDMS with fetal echo specialty) under physician supervision. Documentation should include the interpreting physician's credentials, as some payers deny claims when performed by physicians without documented fetal cardiac imaging training or board certification in relevant specialties.

What diagnosis codes support medical necessity for CPT 76825?

Common ICD-10 codes supporting medical necessity for 76825 include: Z36.0-Z36.9 (antenatal screening), O35.xx (maternal care for known or suspected fetal abnormality), Z82.41 (family history of congenital cardiac disease), O24.xx (diabetes in pregnancy), O35.3 (maternal care for fetal cardiac anomaly), Q24.xx (congenital cardiac anomalies), and specific maternal conditions known to increase cardiac risk. Documentation must link the diagnosis to the specific indication for specialized fetal cardiac evaluation. Using only routine pregnancy codes without documented risk factors frequently results in medical necessity denials.

Should CPT 76825 be billed with modifier 26 or TC in hospital settings?

In hospital or facility settings where the institution owns the ultrasound equipment and employs the sonographer, the technical component (modifier TC) is typically billed by the facility while the interpreting physician bills the professional component (modifier 26) separately. If a physician practice owns the equipment and provides both the technical service and interpretation, the complete code 76825 is billed without modifiers (global service). Incorrect component billing can result in overpayment, underpayment, or duplicate claim denials. Verify the employment and equipment ownership structure to determine proper modifier use.