CPT 76946Radiology

Echo guide for amniocentesis

CPT code 76946 covers ultrasound imaging guidance used during amniocentesis, a prenatal test where a doctor removes amniotic fluid from the uterus. The ultrasound helps the doctor see where to safely insert the needle to avoid harming the baby.

Showing rates for

National Average

Base Medicare rate

$32.35

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

0.38

PE RVU (NF)

0.6

MP RVU

0.02

Total RVU

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

NCCI bundling edits

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Billing tips

Always bill 76946 with the primary amniocentesis procedure code (59000) on the same claim with appropriate sequencing
Impact: Prevents automatic denial; 76946 is an add-on code and will deny if billed alone without the primary procedure
Document real-time continuous imaging throughout needle insertion, not just preliminary scanning before the procedure
Impact: Lack of real-time documentation is the #1 denial reason; can result in 100% payment denial ($32.35 loss per case)
Ensure separate documentation of the ultrasound guidance distinct from the amniocentesis procedure note, including stored images
Impact: Auditors look for separate imaging report with interpretation; missing documentation can trigger recoupment in post-payment audits
Verify the performing physician is credentialed for ultrasound interpretation before billing under their NPI
Impact: Billing under non-credentialed provider can result in denial and potential fraud concerns; may affect entire claim payment
Check for facility vs. non-facility status as both rates are identical ($32.35) but documentation requirements may differ by payer
Impact: While Medicare rates are the same, commercial payers may have different requirements; ensures compliance across all payers
Do not bill 76946 with diagnostic obstetric ultrasound codes (76801, 76805, 76811, 76815) performed same day
Impact: NCCI bundles these services; attempting to bill separately will result in denial and potential upcoding allegations

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76946 in 2025?

The 2025 Medicare national average payment for CPT 76946 is $32.35 for both facility and non-facility settings. This is based on 1.0 total RVUs (0.38 work RVU, 0.6 PE RVU, 0.02 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 76946 be billed alone without an amniocentesis code?

No, CPT 76946 cannot be billed alone. It is an add-on guidance code that must be reported with the primary amniocentesis procedure code 59000. Billing 76946 without the primary procedure will result in automatic denial.

What documentation is required to bill CPT 76946?

Documentation must include explicit evidence of real-time ultrasound guidance during needle insertion, not just preliminary scanning. Required elements include a description of continuous imaging, structures visualized, permanently stored images, and a separate written interpretation signed by a qualified physician.

Is CPT 76946 bundled with diagnostic obstetric ultrasounds?

Yes, CPT 76946 is bundled with comprehensive obstetric ultrasound codes (76801, 76805, 76811, 76815) when performed on the same date according to NCCI edits. The guidance is considered included in the diagnostic ultrasound and should not be separately billed.

Who can bill CPT 76946 for ultrasound guidance?

CPT 76946 must be billed by or under the direct supervision of a physician credentialed in ultrasound interpretation, typically maternal-fetal medicine specialists, obstetricians, radiologists, or perinatologists. The interpreting physician must meet payer-specific ultrasound qualification requirements.

What is the difference between preliminary scanning and billable ultrasound guidance?

Preliminary scanning to identify anatomy before a procedure is not separately billable. CPT 76946 requires real-time continuous ultrasound visualization during actual needle insertion to guide placement and ensure safety. Documentation must specifically state real-time guidance was used throughout the procedure.

How many RVUs is CPT code 76946 worth in 2025?

CPT 76946 has 1.0 total RVUs in 2025, broken down as: 0.38 work RVUs, 0.6 practice expense RVUs (both facility and non-facility), and 0.02 malpractice RVUs. This relatively low RVU value reflects the limited time and resources for guidance compared to comprehensive ultrasounds.