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CPT 76805: Transabdominal Obstetric Ultrasound, Second Trimester
CPT code 76805 denotes a transabdominal ultrasound of a pregnant uterus performed after the first trimester (greater than 14 weeks) for evaluation of a single or first fetus and maternal structures. This code is a core obstetric imaging service used across ambulatory and hospital outpatient settings for fetal assessment in the second and third trimesters. It is nationally important because it supports prenatal diagnosis, guides clinical management, and drives imaging utilization patterns for prenatal care.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and payment policies for 76805 influence access to second‑trimester fetal assessment and can vary by payer policy, medical necessity criteria, and site of service.
Readers will find a concise overview of the clinical context and typical use of 76805, comparisons to related obstetric ultrasound codes, and a summary of payer coverage scope. The publication highlights common clinical indications, expected sites of service, and where 76805 fits within the continuum of prenatal imaging (from limited or follow‑up scans to detailed anatomic examinations). Data not available in the input will be noted where applicable.
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Billing Code Overview
CPT code 76805 describes a transabdominal ultrasound examination of the pregnant uterus performed after the first trimester (more than 14 weeks' gestation) for evaluation of a first or single fetus and maternal structures. The procedure uses real-time imaging via a transabdominal approach to assess fetal and maternal status in the second and third trimesters.
Service Type: Obstetric ultrasound — comprehensive second/third trimester transabdominal exam
Typical Site of Service: Outpatient radiology or obstetrics clinic, hospital outpatient department, or imaging center
National Reimbursement Benchmarks
Medicare's mean rate of $94.2 for CPT 76805 sits well below the BUCA commercial average of $200.1, indicating that Medicare pays roughly $105.9 less on average than this commercial benchmark. This gap highlights a substantial difference between public and commercial reimbursement levels for this ultrasound code.
Dispersion measured as P75 minus P25 varies across payers: Blue Cross Blue Shield has the widest interquartile spread at $119.6 ($297.4 - $197.8), followed by BUCA at $97.4 ($240.9 - $143.5) and Aetna at $58.5 ($144.1 - $58.6). UnitedHealth Group ($168.3 - $80.2) yields a spread of $88.1, Cigna's spread is $110.8 ($184.5 - $74.7), and Medicare's interquartile range is $82 ($131 - $49). These differences reflect meaningful variability in commercial payer pricing.