CPT 76826Radiology

Echo exam of fetal heart

CPT code 76826 covers a specialized ultrasound examination of an unborn baby's heart to check for structural abnormalities and proper function. This detailed imaging study is ordered when there's concern about potential heart defects during pregnancy.

Showing rates for

National Average

Base Medicare rate

$149.12

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

0.83

PE RVU (NF)

3.74

MP RVU

0.04

Total RVU

4.61

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

NCCI bundling edits

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Billing tips

Always verify that the complete fetal echocardiogram criteria are met before billing 76826 rather than the limited study (76825)
Impact: Proper code selection prevents downcoding; 76826 reimburses at $149.12 versus a lower rate for incomplete studies
Document all required cardiac structures including four-chamber view, outflow tracts, three-vessel view, and aortic/ductal arches
Impact: Complete documentation supports medical necessity and prevents denials; incomplete documentation may result in claim rejection or audit recoupment
Bill 76826 separately from routine obstetric ultrasounds (76805/76811) when medically indicated based on risk factors
Impact: These are distinct services when appropriately documented; failure to separate may result in bundling and loss of $149.12 reimbursement
For multiple gestation, bill 76826 with modifier 59 for each additional fetus requiring separate cardiac evaluation
Impact: Appropriate use of modifier 59 allows reimbursement for each fetus examined; improper documentation may result in denial of additional units
Ensure the performing physician has documented specialized training in fetal echocardiography in credentialing files
Impact: Payer credentialing audits increasingly verify subspecialty training; lack of documentation can result in retrospective denials
Link appropriate high-risk ICD-10 diagnosis codes that justify medical necessity for fetal echo rather than routine screening
Impact: Medical necessity documentation prevents denials; use codes such as O35.xx (maternal care for suspected fetal abnormality), Z82.4 (family history of heart disease), or O24.xx (diabetes in pregnancy)

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76826 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 76826 is $149.12 for both facility and non-facility settings. This rate is based on 4.61 total RVUs (0.83 work RVU, 3.74 practice expense RVU, and 0.04 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 76825 and 76826?

CPT 76825 is a follow-up or repeat fetal echocardiogram, while 76826 is a complete fetal echocardiogram. Code 76826 requires comprehensive evaluation of all cardiac structures including chambers, valves, outflow tracts, great vessels, and arches, whereas 76825 is used for limited re-evaluation or when complete study cannot be performed due to technical limitations.

Can CPT 76826 be billed with a routine prenatal ultrasound on the same day?

Yes, CPT 76826 can be billed separately from routine obstetric ultrasounds (76805/76811) when medically indicated, but requires modifier 59 or XU to bypass bundling edits. Documentation must clearly establish that the fetal echocardiogram is a distinct, specialized cardiac evaluation beyond the cardiac views obtained in routine anatomic survey, with separate reports for each examination.

What diagnosis codes support medical necessity for CPT 76826?

Medical necessity for 76826 is supported by diagnosis codes indicating increased risk for fetal cardiac abnormalities including O35.xx series (maternal care for suspected fetal abnormality), O24.xx (gestational or pre-existing diabetes), Z82.41 (family history of sudden cardiac death), Z82.49 (family history of ischemic heart disease), O36.83 (fetal cardiac arrhythmia), and Q20-Q26 series (congenital cardiac malformations in previously affected pregnancy).

Who is qualified to perform and bill CPT code 76826?

CPT 76826 should be performed and billed by physicians with specialized training in fetal echocardiography, typically maternal-fetal medicine specialists, pediatric cardiologists with fetal expertise, or radiologists with advanced training in fetal cardiac imaging. Many payers require documentation of specific fellowship training, certification, or significant experience in fetal echocardiography to credential providers for this service.

How many RVUs is CPT code 76826 worth in 2025?

CPT code 76826 is assigned 4.61 total RVUs in 2025, consisting of 0.83 work RVUs, 3.74 practice expense RVUs (same for both facility and non-facility settings), and 0.04 malpractice RVUs according to the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Can CPT 76826 be billed for each fetus in a multiple gestation pregnancy?

Yes, CPT 76826 can be billed for each fetus requiring separate fetal echocardiogram in a multiple gestation pregnancy. Bill the first fetus without a modifier and subsequent fetuses with modifier 59 or 76 depending on payer preference. Documentation must clearly identify separate cardiac evaluations for each fetus with individual findings and interpretations.