Summary & Overview
CPT 76813: First‑Trimester Nuchal Translucency Ultrasound
CPT code 76813 represents a first‑trimester diagnostic ultrasound measurement of fetal nuchal translucency using transabdominal or transvaginal imaging to assess risk for chromosomal abnormalities in a first or single developing fetus. This code is clinically important for early prenatal risk stratification and counseling, informing downstream genetic testing or monitoring decisions.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of typical clinical contexts and sites of service, payer coverage considerations, common modifier usage (listed separately), and related coding guidance. The publication provides benchmarked utilization patterns, reimbursement considerations, and recent policy or coding updates relevant to first‑trimester nuchal translucency ultrasound services.
The report is intended for healthcare administrators, billing and coding staff, and clinicians involved in prenatal care. It clarifies clinical indications captured by CPT code 76813, outlines settings where the service is commonly provided, and summarizes what billing teams should expect when submitting claims for first‑trimester nuchal translucency measurements across major national payers. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 76813 describes the use of transabdominal or transvaginal ultrasound to measure the fetal nuchal translucency — the clear, fluid‑filled space at the back of the fetal neck — for a first‑trimester assessment of chromosomal or developmental abnormalities in a first or single developing fetus. This measurement is performed to help identify an increased risk of chromosomal anomalies during early pregnancy.
Service type: Diagnostic obstetric ultrasound (first‑trimester nuchal translucency measurement)
Typical site of service: Outpatient obstetrics clinic, maternal‑fetal medicine clinic, radiology department, or ambulatory imaging center, using transabdominal or transvaginal approaches based on gestational age and image quality.
Clinical & Coding Specifications
Clinical Context
A 10-week pregnant patient presents for first-trimester screening. The obstetric provider orders a targeted ultrasound to measure fetal nuchal translucency (NT) to assess risk for chromosomal abnormalities such as trisomy 21, trisomy 18, and neural tube defects. The sonographer performs a transabdominal ultrasound; if inadequate visualization occurs, a transvaginal approach is used. The imaging study documents a mid-sagittal fetal profile, precise caliper placement at the widest NT area, crown–rump length (CRL) measurement within the accepted gestational age window (typically 11 0/7 to 13 6/7 weeks or as institutionally defined for NT measurement), and stores images and measurements in the electronic medical record. The interpreting physician reviews images, documents the measured NT in millimeters, correlates with CRL, and provides an interpretive report including risk assessment or recommendations for further diagnostic testing (cell-free DNA, chorionic villus sampling, or amniocentesis) if indicated. Typical site of service is an outpatient obstetric imaging center, hospital radiology or maternal–fetal medicine clinic. Service type is a diagnostic obstetric ultrasound focused on first-trimester fetal nuchal translucency measurement for a single fetus.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is performed on the same day as the NT ultrasound and is significant and separate from the ultrasound service |