CPT 76817 Transvaginal Ultrasound Reimbursement

CPT code 76817 denotes a transvaginal ultrasound of the pregnant uterus used to examine the fetus and maternal pelvic organs. This diagnostic obstetric imaging code is important nationally because transvaginal ultrasound provides high-resolution early pregnancy assessment, evaluation of fetal viability, and detailed pelvic organ visualization when transabdominal imaging is limited. Accurate coding affects clinical documentation, authorization, and billing across payers.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on the clinical context of transvaginal obstetric ultrasound, typical sites of service, and common billing considerations tied to the procedure. The publication summarizes benchmark payment patterns, relevant policy updates that affect coverage and prior authorization practices, and operational notes on documentation expectations. It also outlines areas where clinical indications commonly justify the transvaginal approach and highlights coding nuances that impact claim adjudication.

This material is written for a national audience of clinicians, billing professionals, and policy analysts seeking an overview of the code’s clinical role, payer coverage landscape, and the policy context that influences reimbursement and utilization.

Billing Code Overview

CPT code 76817 describes a transvaginal ultrasound examination of the pregnant uterus, performed to visualize the fetus and to evaluate maternal pelvic organs using an internal (vaginal) probe. The procedure involves sonographic imaging via a transvaginal approach to assess fetal anatomy, fetal viability, and relevant maternal pelvic structures.

Service type: Diagnostic obstetric ultrasound performed via transvaginal approach
Typical site of service: Outpatient imaging center, hospital outpatient department, or physician office where transvaginal ultrasound can be performed

Clinical Context

A 28-year-old pregnant patient presents to an outpatient obstetrics clinic at 10 weeks gestation with pelvic pain and a history of prior ectopic pregnancy. The obstetrician orders a transvaginal ultrasound to evaluate fetal viability, gestational age, and assess for adnexal masses or free fluid. The patient is escorted to the ultrasound suite. A licensed sonographer or the provider performs 76817 (transvaginal ultrasound of the pregnant uterus) using a transvaginal probe to obtain real-time images of the intrauterine gestational sac, yolk sac, embryo/fetal pole, and cardiac activity, and to evaluate the cervix and adnexa. Images and measurements are captured, preliminary impressions are documented in the exam report, and a formal interpretive report is completed by the performing clinician. Typical workflow includes history review, informed consent, exam performance, image acquisition and measurements, and final documentation in the electronic medical record. Typical site of service is an outpatient obstetrics/gynecology clinic or hospital-based outpatient imaging department. Standard billing uses 76817 for the transvaginal obstetrical ultrasound procedure.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation of the ultrasound and the technical component is billed separately.

Taxonomy Code	Specialty	Notes
2080P0200X	Obstetrics & Gynecology	Obstetrician-gynecologists commonly perform and interpret `76817`.
207Q00000X	Diagnostic Radiology	Diagnostic radiologists may interpret obstetric transvaginal exams in hospital settings.
174H00000X	Maternal-Fetal Medicine	Maternal-fetal medicine specialists perform high-risk obstetric transvaginal ultrasounds.
332B00000X	Nurse Midwife	Certified nurse-midwives may order and sometimes perform transvaginal ultrasounds in outpatient settings.
331K00000X	Nurse Practitioner	Women’s health nurse practitioners may be involved in performing or interpreting point-of-care transvaginal ultrasounds.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O09.011`	Supervision of pregnancy with history of ectopic pregnancy, first trimester	Transvaginal ultrasound `76817` evaluates intrauterine versus ectopic pregnancy in patients with prior ectopic history.
`O20.0`	Threatened abortion	`76817` is used to assess viability and detect subchorionic hemorrhage or fetal cardiac activity.
`O03.9`	Spontaneous abortion, unspecified	Used when evaluating suspected miscarriage; transvaginal imaging provides detailed assessment of retained products.
`O26.89`	Other specified pregnancy-related conditions	Employed when specific pregnancy concerns (e.g., adnexal masses) require transvaginal assessment.
`N83.2`	Torsion of ovary, ovarian pedicle	When pelvic pain in pregnancy prompts evaluation for adnexal pathology alongside fetal assessment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`76815`	Ultrasound, pregnant uterus, real time with image documentation, transabdominal approach; single or first gestation	Often performed before or instead of `76817` when transabdominal imaging is adequate or for initial survey.
`76816`	Ultrasound, pregnant uterus, real time with image documentation, transabdominal approach; each additional gestation (separate procedure)	Used when transabdominal imaging is performed for additional fetuses in a multiple gestation situation alongside `76817` if transvaginal imaging is also required.
`76817`	Ultrasound, pregnant uterus, real time with image documentation, transvaginal	The primary procedure described; used for first-trimester viability, cervical assessment, and adnexal evaluation.
`76857`	Ultrasound, fetal transabdominal or transvaginal, real time with image documentation, limited or follow-up	Performed for limited follow-up assessments or targeted evaluations related to findings on `76817`.
`77067`	Screening breast ultrasound, bilateral	Not directly related to obstetric pelvic imaging but may be performed in the same imaging session for separate indications; modifier `59` required if same-day unrelated imaging is billed.
`76536`	Ultrasound, scrotum and contents	Example of a non-related ultrasound study to illustrate when distinct procedural service modifiers may be required if performed same day.

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Summary & Overview

CPT 76817: Transvaginal Ultrasound of Pregnant Uterus