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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.
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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.