CPT 76827Radiology

Echo exam of fetal heart

CPT code 76827 covers a specialized ultrasound examination of a baby's heart while still in the womb (fetal echocardiography). This detailed imaging study evaluates the structure and function of the fetal heart to detect congenital heart defects.

Showing rates for

National Average

Base Medicare rate

$66.63

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

0.58

PE RVU (NF)

1.45

MP RVU

0.03

Total RVU

2.06

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

NCCI bundling edits

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Billing tips

Document specific anatomic cardiac structures evaluated (four chambers, outflow tracts, great vessels, valves, cardiac axis, situs) to support comprehensive examination
Impact: Prevents downcoding to basic fetal cardiac views (76825); ensures full $66.63 reimbursement rather than reduced payment
Include clear medical necessity statement indicating why fetal echocardiography was ordered beyond routine anatomy ultrasound
Impact: Medical necessity documentation reduces denial rate by 60-70% for this specialized study; critical for payer approval
Bill on separate date from routine anatomy scan when clinically appropriate to avoid bundling denials
Impact: When billed same-day as 76805/76811, use modifier 59 and document distinct session; prevents automatic bundling that eliminates the $66.63 payment
Ensure gestational age is documented as this affects image quality expectations and reimbursement justification
Impact: Studies before 18 weeks or after 30 weeks may face additional scrutiny; proper documentation supports medical necessity regardless of timing
Document physician credentials and fetal cardiac imaging expertise in report header or attestation
Impact: Some payers require proof of specialized training; credentialing issues can delay payment 30-60 days or result in denials
When study is technically limited, document limitations and plan for follow-up rather than billing incomplete exam
Impact: Billing incomplete exam may result in 50-75% payment reduction; better to reschedule and bill complete study at full $66.63

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76827 in 2025?

The 2025 Medicare national average reimbursement for CPT 76827 is $66.63 for both facility and non-facility settings. This rate is based on 2.06 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the Medicare GPCI adjustment.

What is the difference between CPT 76827 and 76825?

CPT 76827 is a complete fetal echocardiogram evaluating all cardiac chambers, valves, outflow tracts, and great vessels, while 76825 represents fetal cardiac views that are part of a complete anatomy ultrasound. Code 76827 requires documentation of specialized cardiac structures beyond the basic four-chamber view and is used when there is specific indication for detailed cardiac assessment.

Can you bill CPT 76827 with a routine anatomy scan on the same day?

Yes, but it requires careful documentation and typically modifier 59. The fetal echocardiogram (76827) must be a distinct service with separate medical necessity beyond the routine anatomy scan (76805/76811). Document the specific cardiac indication, perform the studies as separate sessions when possible, and ensure the 76827 report focuses on detailed cardiac structures not routinely assessed in anatomy scans.

What medical necessity justifies billing CPT 76827?

Medical necessity for 76827 includes maternal conditions (diabetes, phenylketonuria, autoimmune disease), family history of congenital heart disease, abnormal first-trimester screening, suspected cardiac anomaly on routine ultrasound, fetal arrhythmia, hydrops fetalis, chromosomal abnormalities, or exposure to teratogenic medications. Documentation must clearly state why specialized cardiac imaging is needed beyond routine fetal assessment.

How many RVUs is CPT code 76827 worth in 2025?

CPT 76827 has 2.06 total RVUs in 2025, consisting of 0.58 work RVUs, 1.45 practice expense RVUs, and 0.03 malpractice RVUs. The PE RVU value of 1.45 applies to both facility and non-facility settings for this code.

What credentials are required to bill CPT 76827?

Physicians billing 76827 should have specialized training in fetal echocardiography, typically through maternal-fetal medicine or pediatric cardiology fellowship. While no universal credentialing standard exists, many payers expect board certification in MFM or pediatric cardiology, documented fetal cardiac imaging experience, and facility privileges for specialized prenatal diagnosis. Some institutions require minimum case volumes or continuing education in fetal cardiology.

When during pregnancy should CPT 76827 be performed?

Fetal echocardiography (76827) is typically performed between 18-24 weeks gestation when cardiac structures are adequately developed for detailed assessment but early enough for clinical decision-making. Earlier studies (16-18 weeks) may be performed for high-risk patients, while later studies may be needed for follow-up of known anomalies or when late-presenting findings emerge. Gestational age should always be documented as it affects image quality expectations.