Summary & Overview
CPT 76819: Ultrasound-Only Biophysical Profile
CPT code 76819 denotes an ultrasound-only biophysical profile (BPP) used to assess fetal well-being during pregnancy by evaluating ultrasound components without performing a nonstress test. This code is important nationally because BPPs are commonly used in prenatal care to monitor at-risk pregnancies and inform clinical decisions about timing of delivery and additional monitoring. Coverage and reimbursement for this specific ultrasound-only BPP affect maternal-fetal medicine, obstetrics practices, and imaging facilities.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what CPT code 76819 represents, how it is typically provided (service type and sites of service), and which major payers are included in benchmarking and policy review. The publication also summarizes clinical context for the code, common billing considerations, and any notable policy updates affecting ultrasound-based fetal surveillance.
This summary is intended for national audiences including billing professionals, clinicians in obstetrics and maternal-fetal medicine, coding specialists, and policy analysts seeking a clear, practical briefing on CPT code 76819. Data not available in the input that would ordinarily appear in deeper sections—such as fee schedules, payer-specific edits, or associated ICD-10 mappings—is noted as unavailable.
Billing Code Overview
CPT code 76819 describes a biophysical profile (BPP) performed using ultrasound only, without an accompanying nonstress test. The service assesses fetal well-being through ultrasound-based components of the BPP such as fetal breathing, gross body movements, fetal tone, and amniotic fluid volume.
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Service type: Diagnostic ultrasound evaluation for fetal assessment (ultrasound-only biophysical profile)
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Typical site of service: Outpatient obstetrics clinic, maternal-fetal medicine clinic, or hospital ambulatory imaging unit
Clinical & Coding Specifications
Clinical Context
A 36-year-old G2P1 at 36 weeks gestation with fetal growth restriction and decreased fetal movement is scheduled for a biophysical profile using ultrasound only. The patient presents to an outpatient obstetric ultrasound suite at a hospital-affiliated imaging center. The sonographer performs timed real-time ultrasound assessment of fetal breathing, gross body movements, fetal tone, and amniotic fluid volume, and documents a reactive assessment of these parameters without performing an external fetal nonstress test (NST). The provider reviews images and scores the five components to produce a BPP score; the result informs the obstetrician’s decision about ongoing fetal surveillance, timing of delivery, or need for additional testing.
Workflows typically include patient check-in, targeted maternal history and indication confirmation, focused ultrasound acquisition by a sonographer with immediate provider review, electronic documentation of BPP elements and score, and communication of results to the ordering clinician. Typical sites of service are outpatient obstetric imaging departments, hospital-based radiology or maternal-fetal medicine clinics, and freestanding ambulatory ultrasound centers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation separate from technical facility fee |