2025 CPT code 76805

Transabdominal ultrasound of pregnant uterus, fetal and maternal evaluation after 14 weeks gestation; single or first gestation.

Adhere to CPT guidelines for diagnostic ultrasound, ensuring all elements of the code are performed and documented.The written report must accurately reflect the findings or justify any non-visualizations.

Modifiers 26 (professional component only) and TC (technical component only) may apply depending on the billing arrangement. Modifier 59 may be added for each additional fetus after the first if 76810 is also reported.

Medical necessity for this procedure is established when there's a clinical indication for fetal and maternal evaluation after 14 weeks of gestation. This could include routine prenatal care, assessment of suspected fetal abnormalities, evaluation of maternal conditions affecting pregnancy, or management of pregnancy complications.

The clinical responsibility lies with the physician or qualified healthcare professional who performs and interprets the ultrasound examination. This includes obtaining images, performing measurements, assessing fetal and maternal anatomy, and generating a comprehensive report for the patient's medical record.The physician must ensure adherence to established guidelines and protocols for appropriate medical imaging.

IMPORTANT 76801 (first trimester), 76810 (additional gestational sac or fetus), 76811 (detailed fetal anatomy evaluation), 76815 (limited exam), 76816 (reassessment), 76817 (transvaginal ultrasound)

In simple words: This ultrasound checks on the baby and mom after the first three months of pregnancy.The doctor uses a device placed on the belly to get pictures of the baby's heart, brain, and other parts, along with the mom's uterus and ovaries. The ultrasound creates a picture of the baby and helps to see if everything is developing normally.

This CPT code encompasses a real-time transabdominal ultrasound examination of a pregnant uterus, focusing on fetal and maternal evaluation after the first trimester (≥14 weeks 0 days).The examination includes determining the number of fetuses and amniotic/chorionic sacs, performing gestational age-appropriate measurements, surveying intracranial/spinal/abdominal anatomy, assessing the four-chambered heart, noting the umbilical cord insertion site and placental location, and evaluating amniotic fluid volume.When visible, maternal adnexa are also examined.Permanent image documentation with measurements is required. A comprehensive written report detailing the findings or reasons for non-visualization of each element must be provided.

Example 1: A 20-week pregnant patient presents for a routine anatomy scan. The physician performs a transabdominal ultrasound, documenting fetal measurements, assessing anatomy, evaluating amniotic fluid, and examining the placenta. The report details normal findings., A patient at 16 weeks gestation presents for an ultrasound due to concerns about fetal growth.The physician assesses fetal size and compares it to expected measurements based on gestational age. The report indicates that fetal growth is within the normal range., A 22-week pregnant patient presents with abdominal pain. The physician performs an ultrasound to assess for placental abnormalities and to rule out other potential causes for the patient's symptoms.The report describes the findings and provides recommendations for management.

** This code is used for standard obstetric ultrasounds after the first trimester.For detailed anatomical evaluations or focused assessments, consider alternative CPT codes as indicated in the guidelines.

  • Revenue Code: I3B (ECHOGRAPHY - ABDOMEN/PELVIS)
  • RVU: This information is not available in the provided source.RVUs vary based on geographic location and other factors. Consult your local fee schedule.
  • Global Days : This information is not available in the provided source. Consult your local fee schedule or payer guidelines.
  • Payment Status: Active
  • Modifier TC rule: Modifier TC may be appended if reporting the technical component separately.Payer policies vary, and some may not require it for hospital-based services.
  • Fee Schedule : Historical fee schedule data is not available within the provided source.
  • Specialties:Obstetrics and Gynecology, Radiology
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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