2025 CPT code 76812
(Active) Effective Date: N/A Revision Date: N/A Radiology - Fetal Ultrasound Diagnostic Ultrasound Procedures Feed
Add-on code for detailed transabdominal ultrasound examination of each additional fetus beyond the first, including fetal and maternal evaluation.
Modifiers 26 (professional component) and TC (technical component) may apply depending on the provider's role and payer requirements.
Medical necessity for this add-on code is established when a detailed ultrasound examination of each additional fetus is clinically indicated, such as in cases of multiple gestations, suspected fetal anomalies, or high-risk pregnancies.
The clinical responsibility lies with the physician or qualified healthcare professional performing and interpreting the ultrasound. This includes obtaining informed consent, performing the scan, analyzing the images, and generating a comprehensive report.
In simple words: This code is for an extra ultrasound scan of each additional baby beyond the first one if a mother is pregnant with multiples.The scan looks at the babies' bodies in detail and also checks on the mother's health.
This CPT code, 76812, represents an add-on procedure for a detailed transabdominal ultrasound examination of each additional fetus beyond the initial fetus examined using code 76811. The examination includes a comprehensive assessment of fetal anatomy, maternal structures, and other relevant factors.It is crucial to note that this code should only be reported in conjunction with 76811, which covers the initial fetal ultrasound.
Example 1: A pregnant patient with triplets undergoes a transabdominal ultrasound. Code 76811 is used for the first fetus, and code 76812 is reported twice for the additional two fetuses., A pregnant patient with twins has a scheduled ultrasound.The first fetus is evaluated with 76811; because of complications with the second fetus, 76812 is billed in addition to 76811. , A patient with a high-risk pregnancy carrying twins undergoes a detailed ultrasound. 76811 is used for the first twin, and 76812 is billed for the second twin because of a potential abnormality detected in the first twin that necessitates a more comprehensive exam for the second.
* Detailed images of each fetus.* Measurements of each fetus including biometric data such as head circumference, biparietal diameter, femur length, etc.* Assessment of fetal anatomy including brain, heart, abdomen, limbs, umbilical cord.* Evaluation of amniotic fluid volume and placental location.* Maternal uterine and adnexal examination.* Comprehensive report documenting findings for each fetus.
** Accurate reporting of this add-on code requires careful documentation of the additional fetal examinations performed, ensuring that the clinical necessity for each additional scan is clearly justified.It's essential to adhere to all payer-specific guidelines and requirements for reimbursement.
- Payment Status: Active
- Modifier TC rule: Modifier TC may be applicable to the technical component of the service, depending on payer guidelines.
- Specialties:Obstetrics, Gynecology, Radiology
- Place of Service:Office, Hospital (Inpatient/Outpatient), Ambulatory Surgical Center