Summary & Overview
CPT 76801: First-Trimester Transabdominal Obstetric Ultrasound
CPT code 76801 represents a transabdominal, real-time ultrasound of a pregnant uterus for evaluation of a first or single fetus during the first trimester (less than 14 weeks). This early obstetric ultrasound is a common diagnostic service used to confirm viability, estimate gestational age, detect multiple gestations, and identify early maternal or embryonic abnormalities. Nationally, first-trimester obstetric imaging is a routine component of prenatal care and has implications for care pathways, utilization tracking, and payer coverage policies.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for first-trimester transabdominal ultrasound, typical sites of service, common billing considerations, and related code groupings. The publication also summarizes payer coverage patterns and benchmark considerations relevant to this service line and highlights policy updates and coding guidance that affect documentation and billing practices.
This summary is intended to provide clinicians, coders, and policy analysts with a concise reference to the clinical purpose of CPT code 76801, the environments where it is performed, and the payer landscape affecting reimbursement and utilization nationally.
Billing Code Overview
CPT code 76801 describes a real-time ultrasound examination of a pregnant uterus for evaluation of a first or single fetus and the mother during the first trimester (less than 14 weeks' gestation) using a transabdominal approach. This procedure involves live imaging to assess fetal viability, gestational age, cardiac activity, and maternal uterine anatomy in early pregnancy.
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Service type: Diagnostic ultrasound, obstetric (first trimester), transabdominal
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Typical site of service: Outpatient imaging centers, hospital outpatient departments, and physician offices where diagnostic obstetric ultrasound is performed
Clinical & Coding Specifications
Clinical Context
A 28-year-old G1P0 woman presents to the outpatient obstetric ultrasound suite with a positive urine pregnancy test and a last menstrual period consistent with 9 weeks gestation. The ordering obstetrician requests a transabdominal, real-time ultrasound to confirm an intrauterine pregnancy, estimate gestational age, assess fetal cardiac activity, evaluate the number of fetuses, and examine the maternal uterus and adnexa for complications (for example, suspected ectopic pregnancy ruled out on prior evaluation). The technologist performs a live transabdominal scan using a standard curvilinear transducer while the interpreting physician documents real-time image findings, biometric measurements (crown-rump length if visible), fetal heart motion, and a brief anatomic survey appropriate for first-trimester imaging.
Typical workflow: patient registration and verification of identity and pregnancy history; screening for contraindications; bladder preparation as requested; sonographer or ultrasound technologist performs the real-time transabdominal imaging; images and cine loops are captured and submitted to the interpreting provider; the physician documents the interpretation and communicates results to the referring provider and patient. Billing uses 76801 for a single or first-trimester transabdominal real-time fetal ultrasound of a first or single fetus (<14 weeks).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |