CPT 76831Radiology

Echo exam uterus

CPT code 76831 is used for an ultrasound examination of the uterus, a non-invasive imaging test that uses sound waves to create pictures of the uterus and surrounding pelvic structures.

Showing rates for

National Average

Base Medicare rate

$110.63

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

0.72

PE RVU (NF)

2.66

MP RVU

0.04

Total RVU

3.42

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify that all required images are permanently archived before billing; incomplete image documentation is the leading cause of downcoding
Impact: Prevents downcoding to 76830 (non-obstetrical transvaginal ultrasound) or complete denial, protecting the full $110.63 reimbursement
Do not bill 76831 with 76830 on the same date of service for the same patient; these codes are mutually exclusive
Impact: Prevents automatic denial and potential recoupment; one code will be denied as bundled
Document whether exam is transabdominal, transvaginal, or both; specify all structures visualized and measurements obtained
Impact: Reduces audit risk and supports medical necessity; comprehensive documentation supports the 3.42 total RVUs
Bill global code only when your facility owns equipment and provides interpretation; split billing with 26/TC when components are separate
Impact: Ensures correct payment distribution; incorrect component billing can result in overpayment recovery
Verify pregnancy status before billing 76831; if patient is pregnant, use obstetrical ultrasound codes (76801-76817) instead
Impact: Prevents denial for incorrect code selection; obstetrical codes have different reimbursement rates
Link appropriate ICD-10 diagnosis codes that support medical necessity such as abnormal uterine bleeding (N93.9), uterine fibroids (D25.9), or pelvic pain (R10.2)
Impact: Improves first-pass acceptance rate by 30-40% and reduces medical necessity denials

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 76831?

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 76831 in 2025?

The 2025 Medicare national average reimbursement for CPT 76831 is $110.63 for both facility and non-facility settings. This rate is based on 3.42 total RVUs (0.72 work RVU, 2.66 practice expense RVU, 0.04 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 76831 and 76830?

CPT 76831 is specifically for a complete ultrasound examination of the uterus, while 76830 is for a complete transvaginal ultrasound of non-obstetric organs. Code 76830 is more comprehensive and includes evaluation of the uterus, ovaries, adnexa, and cul-de-sac, whereas 76831 focuses specifically on the uterus. These codes are mutually exclusive and should not be billed together for the same encounter.

Can CPT 76831 be billed for pregnant patients?

No, CPT 76831 should not be used for pregnant patients. For obstetrical ultrasounds, use the appropriate OB ultrasound codes from the 76801-76817 range depending on trimester and type of exam. CPT 76831 is specifically for non-obstetrical gynecologic examination of the uterus.

Do I need modifier 26 or TC when billing CPT 76831?

Use modifier 26 when billing only the professional component (interpretation and report) if you don't own the equipment. Use modifier TC when billing only the technical component (equipment and technologist) if another physician provides interpretation. Bill the global code without modifiers only when your practice provides both components.

How often can CPT 76831 be billed for the same patient?

There is no specific Medicare frequency limitation for CPT 76831, but medical necessity must be established for each exam. Payers may question repeat exams within short timeframes. Documentation should clearly explain why repeat imaging is necessary, such as monitoring fibroid growth, evaluating response to treatment, or investigating new symptoms.

What documentation is required to support billing CPT 76831?

Required documentation includes medical indication, complete uterine measurements in three dimensions, endometrial thickness, myometrial description, cervical evaluation, permanent archived images, and a signed interpretation report by a qualified physician. The report must demonstrate a complete focused examination of the uterus meeting all elements of the code descriptor.

Can CPT 76831 be billed with a pelvic ultrasound code 76856 on the same day?

Generally no, because CPT 76856 (complete pelvic ultrasound) already includes examination of the uterus along with ovaries and adnexa. Billing both codes together would be considered unbundling. Only bill 76831 when the exam is specifically focused on the uterus. If a complete pelvic exam is performed, use 76856 instead.