2025 CPT code 76811

Transabdominal ultrasound of pregnant uterus with image documentation, evaluating both fetus and mother, including detailed fetal anatomy examination.

Only one 76811 per pregnancy is generally appropriate unless new clinical findings warrant further evaluation.Modifiers may be necessary for additional fetuses or when performed with other procedures.

Modifiers 26 (professional component), TC (technical component), 59 (distinct procedural service), and others may be applicable depending on the circumstances.

Medical necessity is established in cases of suspected or known fetal anomalies, increased risk for anomalies (e.g., advanced maternal age, diabetes, exposure to teratogens), or when a detailed anatomical assessment is clinically indicated to guide management.

Obstetrician-Gynecologist, Maternal-Fetal Medicine Specialist, Radiologist

IMPORTANT 76801, 76802, 76805, 76810, 76812 (for additional fetuses), 76815 (limited exam), 76816 (follow-up), 76817 (transvaginal component)

In simple words: This ultrasound uses sound waves to create detailed images of the baby and mother during pregnancy. It goes beyond a standard check-up, looking closely at the baby's brain, heart, spine, and other organs.It also checks the mother's uterus and surrounding areas. The doctor will take pictures and write a detailed report.

This CPT code encompasses a comprehensive transabdominal ultrasound examination of a pregnant uterus, documenting findings with real-time images.The examination includes a detailed evaluation of fetal anatomy, encompassing intracranial, facial, and spinal structures; heart, including outflow tracts; chest; abdominal organs; limbs; umbilical cord; and placenta.Maternal structures, including the uterus and adnexa, are also assessed.Amniotic fluid volume is qualitatively assessed.The procedure requires thorough evaluation of the specified anatomical regions, image documentation, and a comprehensive written report including measurements where clinically indicated. The level of detail exceeds routine obstetric ultrasounds and is reserved for cases with known or suspected fetal abnormalities or increased risk factors.

Example 1: A pregnant patient presents with a family history of congenital heart defects.A 76811 ultrasound is performed to meticulously assess the fetal cardiac structures., A patient at 20 weeks gestation has a previous ultrasound indicating possible neural tube defect. 76811 is used for detailed evaluation of fetal spine and brain., Following an abnormal screening test result, a detailed fetal anatomy ultrasound (76811) is recommended to rule out or confirm anomalies.

Detailed ultrasound images, fetal biometric measurements, written report detailing all anatomical structures evaluated (or reason for non-visualization), and maternal findings.

** Code 76811 is not intended for routine prenatal screening.Appropriate documentation is crucial for accurate coding and reimbursement.

  • Payment Status: Active
  • Modifier TC rule: Modifier TC may apply for the technical component, particularly in hospital settings, depending on payer policies.
  • Specialties:Obstetrics & Gynecology, Maternal-Fetal Medicine, Radiology
  • Place of Service:Office, Hospital (Inpatient/Outpatient), Ambulatory Surgical Center
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