Summary & Overview

CPT 76805: Obstetrical Ultrasound After First Trimester, Single Gestation

CPT code 76805 represents a standard obstetrical ultrasound performed after the first trimester, specifically for single or first gestation pregnancies. This procedure is a cornerstone of prenatal care, providing real-time imaging to evaluate both fetal and maternal health. The service is most commonly delivered in outpatient office settings and is critical for ongoing assessment of pregnancy progression and early detection of potential complications.

Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, recognize and reimburse for this code, underscoring its widespread clinical and billing relevance. Readers will gain insight into the clinical context of 76805, its role in routine prenatal screening, and the typical sites of service. The publication also covers related billing modifiers, associated taxonomies, and ICD-10 diagnoses, offering a comprehensive overview for stakeholders interested in policy updates, reimbursement benchmarks, and coding practices. This summary provides a clear understanding of how 76805 fits into the broader landscape of obstetrical ultrasound services and its importance in maternal-fetal medicine.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 76805obstetrical ultrasoundprenatal carematernal evaluationfetal evaluationoutpatient officemedical billingclinical documentationpregnancy monitoringreal-time imaging

CPT Code Overview

CPT code 76805 is used to report an obstetrical ultrasound performed on a pregnant uterus after the first trimester (at or beyond 14 weeks 0 days). This procedure utilizes real-time imaging with documentation to evaluate both fetal and maternal health. The service is typically conducted using a transabdominal approach and is applicable for single or first gestation pregnancies. The most common site of service for this ultrasound is the outpatient office setting (Place of Service 11). This code is essential for monitoring pregnancy progression and ensuring comprehensive maternal and fetal assessment during routine prenatal care.

Clinical & Coding Specifications

Clinical Context

A pregnant patient presents to the outpatient office (Place of Service 11) for a routine obstetrical ultrasound after the first trimester, at or beyond 14 weeks 0 days gestation. The purpose of the visit is to evaluate both fetal and maternal health using a transabdominal ultrasound. The provider documents real-time images to assess fetal growth, anatomy, and maternal structures. This procedure is typically performed by an obstetrician, gynecologist, or radiologist, and is commonly ordered as part of antenatal screening to monitor pregnancy progression and identify any potential complications.

Coding Specifications

Modifiers:
- Modifier 26: Used when reporting only the professional component (interpretation and report) of the ultrasound service.
- Modifier TC: Used when reporting only the technical component (equipment, supplies, and technician) of the ultrasound service.
- Modifier 59: Used to indicate a distinct procedural service when multiple procedures are performed and are not normally reported together.
Provider Taxonomies:

Taxonomy Code Specialty

National Reimbursement Benchmarks

Medicare's national mean rate for CPT code 76805 is $94.24, which is significantly lower than the BUCA (average commercial) mean rate of $125.60. Commercial payers such as Blue Cross Blue Shield, Cigna, and UnitedHealth Group all report mean rates well above Medicare, with Cigna having the highest at $144.99.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare shows the widest spread at $82.00, indicating substantial variability in rates. In contrast, Aetna has the tightest range at $44.38, suggesting more consistent reimbursement levels. The table and chart below present the full breakdown of national benchmarks for each payer.

National Mean Rates by Payer for CPT Code `76805`

Related CPT Codes

76811: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation
- Used for a more detailed fetal anatomical assessment beyond the standard evaluation in 76805. May be performed when additional detail is clinically indicated.
76815: Ultrasound, pregnant uterus, real time with image documentation, limited (e.g. fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses
- Used for a limited evaluation, such as checking fetal heart beat or placental location. May be used as an alternative or in conjunction with 76805 for specific clinical questions.
76816: Ultrasound, pregnant uterus, real time image documentation, follow‑up (e.g. re‑evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re‑evaluation of organ system(s) suspected or confirmed to be abnormal on previous scan), transabdominal approach, per fetus
- Used for follow-up ultrasounds to re-evaluate fetal size or organ systems previously identified as abnormal. Often used after an initial scan with 76805 to monitor ongoing concerns.

These codes may be used together or as alternatives depending on the clinical scenario and the level of detail required.

`207P00000X`	Obstetrics & Gynecology
`207RC0000X`	Radiology

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Summary & Overview

CPT 76805: Obstetrical Ultrasound After First Trimester, Single Gestation

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

Related Codes