CPT 76857Radiology

Us exam pelvic limited

CPT code 76857 covers a limited ultrasound examination of the pelvic area, typically performed when the provider needs to evaluate a specific pelvic structure or follow up on a previously identified finding rather than conduct a comprehensive pelvic exam.

Showing rates for

National Average

Base Medicare rate

$48.52

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

0.5

PE RVU (NF)

0.97

MP RVU

0.03

Total RVU

1.5

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

NCCI bundling edits

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Billing tips

Clearly document why the limited exam (76857) was appropriate instead of a complete pelvic ultrasound (76856). Specify which specific structure(s) were examined and the clinical reason for limiting the scope.
Impact: Prevents downcoding from complete to limited or denials for insufficient documentation; can protect full $48.52 reimbursement
For follicle monitoring during fertility treatment, bill 76857 for each monitoring session with appropriate diagnosis codes linking to infertility treatment, not screening codes.
Impact: Ensures coverage for serial exams; improper diagnosis coding can result in denials of multiple claims worth $48.52 each
When performing both transabdominal and transvaginal approaches during the same limited exam, do not bill separately—76857 includes both approaches when performed together for the limited evaluation.
Impact: Prevents unbundling denials and potential fraud allegations; duplicate billing could trigger recoupment of $48.52 plus penalties
Verify that the documented images and report match the limited scope. If all pelvic structures were evaluated comprehensively, bill 76856 instead to avoid downcoding.
Impact: 76856 reimburses at higher rate; undercoding to 76857 leaves money on the table while overcoding risks audit and recoupment
For IUD checks or bladder-only evaluations, ensure documentation explicitly states the limited nature and medical necessity rather than using templates designed for complete exams.
Impact: Template misuse is a red flag for auditors; proper documentation supports the 1.5 RVU valuation and prevents denials
When billing globally (no modifier), ensure your practice owns the equipment and employs the interpreting physician. Split billing 26/TC when services occur in facilities where you don't own equipment.

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Frequently asked questions

What is the difference between CPT 76856 and 76857?

CPT 76856 represents a complete pelvic ultrasound examining all pelvic structures (uterus, cervix, both ovaries, both adnexa, bladder, and cul-de-sac), while 76857 is a limited exam focusing on one or more specific structures rather than comprehensive evaluation. 76857 is appropriate for targeted assessments like follicle monitoring, IUD checks, or follow-up of known findings, while 76856 is used for comprehensive diagnostic evaluation of pelvic symptoms or screening.

How much does Medicare pay for CPT code 76857 in 2025?

Medicare pays $48.52 for CPT 76857 in 2025 based on the national average non-facility rate. This applies to both facility and non-facility settings. The code has 1.5 total RVUs (0.5 work RVU, 0.97 PE RVU, 0.03 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can you bill 76857 multiple times for the same patient?

Yes, 76857 can be billed for multiple sessions when medically necessary, such as serial follicle monitoring during fertility treatment. Each exam must have clear documentation of medical necessity and specific clinical indication. Billing multiple exams on the same day requires modifier 76 and strong justification. Most payers have frequency limitations, so treatment protocols should be documented to support repeated services.

Does 76857 include both transvaginal and transabdominal ultrasound?

Yes, CPT 76857 includes both transvaginal and transabdominal approaches when both are performed as part of the same limited examination. You should not bill separately for each approach. The code encompasses whichever imaging method(s) the physician determines necessary to adequately evaluate the specific limited structures being examined.

What diagnosis codes support medical necessity for 76857?

Common supporting diagnoses include N83.20 (unspecified ovarian cyst), Z30.430 (encounter for insertion of intrauterine contraceptive device), N97.9 (female infertility), N93.9 (abnormal uterine bleeding), Z31.41 (encounter for fertility testing), and R10.2 (pelvic pain). Screening codes (Z12.xx) generally do not support coverage. The diagnosis must justify why a limited rather than complete exam was appropriate.

Can CPT 76857 be billed with an E/M visit on the same day?

Yes, 76857 can be billed with an E/M service (99202-99215) on the same day if both services are medically necessary and separately documented. The ultrasound must be a distinct service beyond the physical examination component of the E/M visit. No modifier is typically required as these are different service categories, but documentation must clearly show both services were performed and medically appropriate.

What are the documentation requirements for billing 76857?

Documentation must include: specific indication for the limited exam, identification of which pelvic structures were examined (and implicitly which were not), imaging approach used, relevant measurements, interpretation with clinical correlation, physician signature and date, and permanent image storage. The report must clearly demonstrate why the exam scope was appropriately limited rather than comprehensive, supporting the use of 76857 instead of 76856.