2025 CPT code 76801
(Active) Effective Date: N/A Revision Date: N/A Radiology - Obstetric Ultrasound Diagnostic Ultrasound Procedures Feed
First-trimester transabdominal ultrasound of a pregnant uterus for fetal and maternal evaluation; single or first gestation.
Modifiers may apply depending on the circumstances of the service.Common modifiers include 26 (professional component), TC (technical component), 59 (distinct procedural service), etc.
Medical necessity for a 76801 ultrasound is typically established by the presence of specific clinical indications, such as vaginal bleeding, abdominal pain, suspected ectopic pregnancy, previous pregnancy complications, or the need for accurate gestational dating. In many cases, it's a routine part of prenatal care in a low risk pregnancy.
The clinical responsibility includes performing the ultrasound examination, interpreting the images, and creating a written report detailing findings and measurements. The physician or qualified medical professional is responsible for accurate image acquisition and analysis. This ensures correct diagnosis and management of the pregnancy.
In simple words: This ultrasound checks on the baby and mother during the first three months of pregnancy. It uses sound waves to create pictures of the baby and the mother's uterus (womb), looking at things like the baby's size, the amount of fluid around the baby, and the baby's organs.
This code represents a real-time transabdominal ultrasound of a pregnant uterus performed during the first trimester (less than 14 weeks 0 days gestation) for a single or the first fetus in a multiple gestation pregnancy. The examination includes determination of the number of gestational sacs and fetuses, gestational sac/fetal measurements appropriate for gestation, a survey of visible fetal and placental anatomic structures, a qualitative assessment of amniotic fluid volume/gestational sac shape, and an examination of the maternal uterus and adnexa.Permanent image documentation and a written report detailing the findings of each element examined or the reason for non-visualization are required.
Example 1: A 35-year-old woman presents for her first prenatal visit at 8 weeks gestation.A 76801 ultrasound is performed to confirm intrauterine pregnancy, assess fetal viability, determine gestational age, and screen for early fetal anomalies., A 28-year-old woman with a history of early pregnancy loss presents at 10 weeks gestation with vaginal bleeding. A 76801 ultrasound is used to assess fetal viability and placental location, and rule out ectopic pregnancy., A 32-year-old woman at 12 weeks gestation presents for a routine first-trimester ultrasound. The 76801 is performed to assess fetal growth and anatomy, screen for major congenital anomalies, and evaluate maternal anatomy (uterus and adnexa).
** Code 76802 is added for each additional gestation in a multiple gestation pregnancy.This code should only be used for a complete first trimester ultrasound examination, which includes detailed assessments of the maternal and fetal anatomy, and documented images. If the ultrasound is limited in scope, code 76815 should be considered. Always refer to the most current CPT manual and coding guidelines for definitive instructions.Consult your payer for specific reimbursement policies.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier may be applicable, depending on payer policies and whether the physician is billing for the technical or professional component, or both.
- Fee Schedule : Fee schedules vary depending on payer and location. Consult your payer's fee schedule for the most up-to-date information.Historical data is not readily available in this context.
- Specialties:Obstetrics and Gynecology, Radiology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center