Summary & Overview
CPT 76818: Biophysical Profile for Fetal Well-Being
CPT code 76818 represents the biophysical profile (BPP), a combined nonstress test and obstetric ultrasound used to evaluate fetal health during pregnancy. The BPP is widely used in prenatal care to help identify fetuses at risk of hypoxia or other complications and to guide clinical decision‑making about monitoring and timing of delivery. Nationally, this code is relevant to hospitals, obstetrics clinics, and maternal‑fetal medicine practices that perform fetal surveillance.
Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 76818, typical sites of service, and the main areas where billing and coverage discussions arise. The report summarizes common modifiers associated with the service and highlights typical payer considerations for obstetric fetal surveillance.
This publication also provides benchmarks and operational guidance areas such as expected use cases, documentation elements tied to the BPP components, and the interaction between the nonstress test and ultrasound elements of the service. Data not available in the input is identified explicitly where relevant.
Billing Code Overview
CPT code 76818 describes a biophysical profile (BPP) performed to assess fetal well‑being during pregnancy. The service combines a nonstress test (NST) with an ultrasound assessment to evaluate parameters such as fetal breathing, movement, tone, amniotic fluid volume, and reactive heart rate.
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Service type: Fetal surveillance combining obstetric ultrasound and cardiotocography
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Typical site of service: Hospital outpatient department, obstetrics clinic, or maternal‑fetal medicine unit
Clinical & Coding Specifications
Clinical Context
A 34-year-old gravida 2 para 1 patient at 37 weeks' gestation presents to an outpatient obstetric clinic for fetal surveillance after reduced fetal movement and a history of gestational hypertension. The obstetrician orders a biophysical profile test, 76818, which combines a nonstress test (NST) and a targeted obstetrical ultrasound to assess fetal breathing, movement, tone, amniotic fluid volume, and NST-reactivity. The patient is registered at the clinic, vitals are obtained, and electronic medical record documentation includes indication, gestational age, and prior fetal testing. A licensed sonographer performs the ultrasound component under physician supervision; the physician interprets the NST and the ultrasound findings and documents the composite BPP score and clinical impression. The typical workflow includes check-in, NST placement and monitoring (20–40 minutes as needed), ultrasound imaging (to assess biophysical components), physician review and interpretation, and counseling to the patient regarding results and next steps. Typical sites of service are outpatient obstetrics clinics, maternal-fetal medicine offices, and hospital-based labor and delivery units when inpatient monitoring is required.
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 or other service | When a distinct E/M visit is provided on the same day as for evaluation beyond the BPP interpretation |