2025 CPT code 76856
(Active) Effective Date: N/A Revision Date: N/A Radiology - Diagnostic Ultrasound Procedures Radiology Feed
Complete transabdominal pelvic ultrasound with image documentation and a comprehensive report.
Modifiers may be applicable depending on the circumstances of the service.Consult the CPT manual and local payer guidelines.
Medical necessity for a pelvic ultrasound is established by symptoms or clinical findings suggesting pathology within the pelvic organs.Examples include pelvic pain, abnormal bleeding, infertility, suspected masses or abnormalities detected on physical examination, and monitoring of known conditions.
The radiologist or sonographer performs the ultrasound, interpreting the images and creating the report. The referring physician orders the test and integrates the findings into the patient's overall care.
In simple words: A pelvic ultrasound is a picture of the organs in your lower belly.For women, this includes the uterus, ovaries, and fallopian tubes, and for men, the bladder and prostate. The doctor uses sound waves to create the picture and looks for any problems.
This CPT code encompasses a thorough transabdominal ultrasound examination of the pelvis, providing a complete evaluation of the relevant anatomy and identifying any present pathologies.For females, this includes detailed description and measurements of the uterus and adnexal structures, endometrial thickness, bladder volume (if applicable), and documentation of any observed pelvic abnormalities (e.g., ovarian cysts, uterine fibroids, free fluid). In males, the examination involves assessment and measurement (where applicable) of the urinary bladder, evaluation of the prostate and seminal vesicles (to the extent visible transabdominally), and documentation of any pelvic pathologies (e.g., bladder tumors, prostatic enlargement, free pelvic fluid, abscesses). The examination requires permanently recorded images with measurements (when clinically indicated) and a comprehensive written report.
Example 1: A 35-year-old female presents with pelvic pain and irregular menstrual bleeding. A transabdominal pelvic ultrasound (76856) is performed to evaluate the uterus, ovaries, and adnexa for abnormalities such as cysts, fibroids, or endometriosis., A 60-year-old male presents with urinary frequency and hesitancy. A transabdominal pelvic ultrasound (76856) is performed to assess the prostate, bladder, and seminal vesicles for potential pathology, such as benign prostatic hyperplasia (BPH) or bladder cancer., A 28-year-old female is undergoing infertility workup. A transabdominal pelvic ultrasound (76856) is performed to assess the ovaries for follicle development and the uterus for structural abnormalities that may affect fertility.
* Physician's order specifying the reason for the ultrasound.* Patient demographics and relevant medical history.* Detailed description of the ultrasound findings, including measurements.* Permanently recorded images.* Comprehensive written report summarizing the results and clinical implications.
** This code is for transabdominal ultrasound only.If a transvaginal approach is used, code 76830 should be used.76856 and 76830 may be reported together, but not always.
- Revenue Code: I3B (ECHOGRAPHY - ABDOMEN/PELVIS)
- RVU: This information is not available in the provided text.RVUs vary by payer and location. Consult your specific payer's fee schedule.
- Global Days: Not applicable.This is a diagnostic imaging code.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier is typically not applicable to this professional code.
- Fee Schedule: Historical fee schedule data is not included in the provided text. Consult your local payer's fee schedule for historical data.
- Specialties:Obstetrics & Gynecology, Urology, Radiology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center