CPT 76830Radiology

Transvaginal us non-ob

CPT code 76830 covers a transvaginal ultrasound performed for non-pregnancy (non-obstetric) purposes, such as evaluating pelvic pain, abnormal bleeding, ovarian cysts, or uterine abnormalities. This imaging procedure uses a specialized probe inserted into the vagina to obtain detailed images of the uterus, ovaries, and surrounding pelvic structures.

Showing rates for

National Average

Base Medicare rate

$114.18

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

0.69

PE RVU (NF)

2.79

MP RVU

0.05

Total RVU

3.53

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

NCCI bundling edits

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Billing tips

Never bill 76830 for pregnancy-related ultrasounds; use obstetric ultrasound codes (76801-76817) instead, even in early first trimester
Impact: Prevents automatic denials and potential recoupment of the full $114.18 payment
Document all required elements including uterine size/orientation, endometrial thickness, myometrial texture, cervical appearance, both ovaries with measurements, and adnexal structures
Impact: Reduces audit risk and supports medical necessity; missing elements can trigger downcoding or 30-50% payment reduction
Bill same day as office visit (E/M) only when separately identifiable condition prompts the ultrasound; append modifier 25 to E/M code, not to 76830
Impact: Ensures payment for both services; improper modifier placement could result in loss of E/M payment ($100-$200)
Verify insurance authorization requirements before performing; many payers require pre-authorization for outpatient ultrasounds
Impact: Prevents denials for lack of authorization which can result in complete write-off of $114.18 plus patient satisfaction issues
Use specific ICD-10 codes linking to the exact indication (abnormal bleeding, pelvic mass, etc.) rather than vague symptoms; avoid Z codes when specific diagnosis available
Impact: Increases first-pass claim acceptance rate by 15-20% and reduces medical necessity denials
Store images in PACS or permanent archive with minimum retention of 7 years; ensure hard copy or electronic images are readily retrievable for audit
Impact: Protects against recoupment during audits; failure to produce images can result in 100% payment recovery demand

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76830 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 76830 is $114.18 for both facility and non-facility settings. This rate is based on 3.53 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the Medicare Administrative Contractor (MAC) regional adjustments.

Can CPT 76830 be billed with an office visit on the same day?

Yes, CPT 76830 can be billed with an E/M office visit on the same day when the ultrasound is a separately identifiable service prompted by distinct clinical findings or symptoms. You must append modifier 25 to the E/M code (not to 76830) and ensure separate documentation supports both services. The ultrasound and office visit must address separate clinical concerns or the ultrasound must be prompted by findings during the E/M.

What is the difference between CPT 76830 and 76817?

CPT 76830 is used for transvaginal ultrasound for non-obstetric (gynecologic) purposes, while 76817 is specifically for transvaginal obstetric ultrasound of a pregnant uterus. The key distinction is pregnancy status: if evaluating a known or suspected pregnancy, use 76817 or other obstetric codes (76801-76816); if evaluating gynecologic pathology without pregnancy, use 76830. Using the wrong code will result in denials.

How many RVUs is CPT code 76830 worth?

CPT code 76830 has a total of 3.53 RVUs for 2025, broken down as: 0.69 work RVUs, 2.79 practice expense RVUs (both facility and non-facility), and 0.05 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Does CPT 76830 require prior authorization from insurance?

Prior authorization requirements vary by insurance payer and specific plan. Many commercial payers and Medicare Advantage plans do require prior authorization for outpatient ultrasound procedures including 76830, while Original Medicare typically does not. Always verify authorization requirements with the specific payer before performing the procedure to avoid denials. Check the patient's specific plan benefits and authorization requirements.

Can 76830 and 76856 be billed together?

No, CPT 76830 (transvaginal ultrasound) and 76856 (pelvic ultrasound complete) should not typically be billed together for the same examination as they represent different approaches to pelvic imaging. If both transabdominal and transvaginal approaches are performed during the same encounter, most payers consider 76830 the more comprehensive code. Check specific payer policies, but generally billing both together will result in bundling denials.

What diagnosis codes support medical necessity for CPT 76830?

Common ICD-10 codes supporting medical necessity for 76830 include: N93.9 (abnormal uterine bleeding), N94.89 (pelvic pain), N83.20 (ovarian cyst), N92.0 (excessive menstruation), N97.9 (female infertility), R19.00 (abdominal/pelvic mass), D25.9 (uterine leiomyoma), and N85.00 (endometrial hyperplasia). The diagnosis must clearly establish a gynecologic indication; pregnancy-related diagnoses should use obstetric ultrasound codes instead.