CPT 76828Radiology

Echo exam of fetal heart

CPT code 76828 covers a specialized ultrasound examination of an unborn baby's heart to check for structural abnormalities or heart defects. This detailed imaging study helps doctors detect congenital heart conditions before birth.

Showing rates for

National Average

Base Medicare rate

$46.58

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

0.56

PE RVU (NF)

0.86

MP RVU

0.02

Total RVU

1.44

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Document the complete four-chamber view, outflow tracts, and three-vessel view explicitly in the report to meet medical necessity requirements
Impact: Missing these key elements accounts for 35% of denials; complete documentation ensures full $46.58 payment
Bill 76828 separately from routine obstetric ultrasounds (76805/76811) only when medical necessity for dedicated cardiac evaluation is documented
Impact: Unbundling without proper indication triggers automatic denials; ensure risk factors are documented in chart and claim
Use modifier 26 in hospital settings where you provide only interpretation services; verify facility is billing TC component
Impact: Incorrect modifier usage can result in 100% claim rejection or duplicate payment recovery
Link appropriate ICD-10 codes indicating maternal risk factors (O35.x series) or suspected fetal anomalies (O36.x series) to establish medical necessity
Impact: Generic or routine screening diagnoses increase denial risk by 40%; specific high-risk indications support reimbursement
Submit study between 18-24 weeks gestation when possible; earlier or later timing requires additional justification
Impact: Out-of-window timing increases audit risk and may require peer-to-peer review for payment approval
Verify that images are permanently stored and retrievable for audit purposes; include image count in documentation
Impact: Missing images during audit can result in recoupment of payments plus potential fraud investigation

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 76828?

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

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76828 in 2025?

The 2025 Medicare national average payment for CPT 76828 is $46.58 for both facility and non-facility settings. This rate is based on 1.44 total RVUs (0.56 work RVU, 0.86 practice expense RVU, 0.02 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 76828 be billed with a routine prenatal ultrasound on the same day?

Yes, but only when medically necessary and documented as distinct procedures. Use modifier 59 to indicate the fetal echocardiogram (76828) is a separate, specialized cardiac evaluation beyond the cardiac views included in comprehensive obstetric ultrasounds (76805/76811). Documentation must clearly establish the medical necessity for dedicated fetal cardiac imaging based on specific risk factors.

What diagnoses support medical necessity for billing 76828?

Appropriate diagnoses include maternal diabetes (O24.x), family history of congenital heart disease (O35.xx), suspected fetal cardiac anomaly (O35.8), fetal arrhythmia (O36.83), maternal medication exposure (O35.5), abnormal nuchal translucency, or other high-risk maternal conditions. Routine screening without documented risk factors typically results in denial.

Who can perform and bill for fetal echocardiography?

Physicians with specialized training in fetal cardiac imaging can bill 76828, typically including maternal-fetal medicine specialists, pediatric cardiologists with fetal imaging training, and radiologists with fetal echocardiography expertise. The interpreting physician must supervise the examination and provide a written report. Sonographers perform the technical component under physician supervision.

How many times can CPT 76828 be billed during a single pregnancy?

There is no specific Medicare frequency limit, but each fetal echocardiogram must be medically necessary and documented. Common scenarios for repeat studies include follow-up of previously identified abnormality, interval development of new risk factors, or inadequate initial visualization requiring repeat examination. Each occurrence requires separate clinical justification.

What is the difference between CPT 76828 and 76825?

CPT 76828 is a comprehensive fetal echocardiographic examination focusing exclusively on detailed cardiac structure and function, while 76825 is a follow-up or repeat fetal echocardiogram. Code 76828 is used for initial or complete fetal cardiac evaluations, whereas 76825 is for limited re-evaluations of previously identified findings and has different documentation requirements and typically lower reimbursement.

Do I need modifier 26 when billing 76828 in a hospital setting?

Yes, if you are only providing the professional component (interpretation and report) in a hospital outpatient department or other facility setting. Use modifier 26 to indicate you are billing only for the physician work, while the facility separately bills the technical component (TC) for equipment, staff, and supplies. Billing the global service (without modifier) in a facility setting typically results in overpayment and recoupment.