CPT 76857 Pelvic Ultrasound Reimbursement | OpenPayer

Summary & Overview

CPT 76857: Pelvic Ultrasound, Diagnostic Imaging

CPT code 76857 represents a pelvic ultrasound study — a diagnostic, noninvasive imaging procedure that documents one or more pelvic structures for clinical evaluation. Pelvic ultrasound is widely used across specialties including obstetrics/gynecology, urology, and general radiology. Nationally, this code is important for clinicians and billing teams because it captures a common imaging service that informs diagnosis and management of pelvic pain, masses, infertility, and other pelvic conditions.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for use of CPT code 76857, typical sites of service, common billing modifiers and administrative considerations (listed separately), and pointers to related imaging services. The publication also summarizes benchmarks and policy considerations where available and identifies areas labeled "Data not available in the input" when input fields were not provided.

This report is intended for a national audience of clinicians, coding professionals, and policy analysts who need a concise reference on CPT code 76857, including coding purpose, service setting, and payer coverage context.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare76857CPTpelvic ultrasounddiagnostic imagingradiologyobstetrics and gynecologyurologyoutpatient imaging

Billing Code Overview

CPT code 76857 describes a pelvic ultrasound, a noninvasive imaging procedure used to assess one or more pelvic structures. For females, this may include the bladder, ovaries, uterus, cervix, and fallopian tubes; for males, it may include the bladder, prostate gland, and seminal vesicles. Images are displayed on a monitor and recorded for a permanent record.

Service type: Diagnostic ultrasound imaging

Typical site of service: Outpatient imaging centers, hospital outpatient departments, and clinic-based radiology or obstetrics/gynecology suites

Clinical & Coding Specifications

Clinical Context

A typical patient is a 28-year-old female presenting to an outpatient imaging center with pelvic pain and irregular vaginal bleeding. The referring clinician (obstetrician-gynecologist or primary care physician) orders a diagnostic pelvic ultrasound to evaluate the uterus, ovaries, and adnexa. The patient is triaged at registration, escorted to an ultrasound room, and screened for pregnancy. A sonographer performs a transabdominal and, if indicated, transvaginal ultrasound using real-time imaging; images are captured and stored for interpretation. The interpreting physician (radiologist or OB/GYN with ultrasound credentialing) reviews the images, generates a signed report, and the results are communicated to the referring clinician for management decisions. Typical sites of service include outpatient radiology centers, hospital outpatient departments, and physician office-based imaging suites. Male patients may receive pelvic ultrasound for evaluation of the bladder, prostate gland, or seminal vesicles under similar workflows.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation/report for the ultrasound when the technical component is billed separately.
`TC`

CPT 76830: Transvaginal Ultrasound Pelvic Examination

CPT-76856-PELVIC-ULTRASOUND-DIAGNOSTIC-IMAGING

CPT 76856: Pelvic Ultrasound, Diagnostic Imaging

CPT-76831-HYSTEROSONOGRAPHY-SALINE-INFUSION-ULTRASOUND

CPT 76831: Hysterosonography with Saline Infusion Ultrasound

Taxonomy Code	Specialty	Notes
2080P0800X	Diagnostic Radiology	Radiologists frequently interpret pelvic ultrasound studies.
207V00000X	Obstetrics & Gynecology	OB/GYNs perform and interpret pelvic ultrasound for female pelvic pathology and pregnancy.
174400000X	Family Medicine	Family physicians may order and sometimes perform point-of-care pelvic ultrasound in office settings.
363LP0200X	Urology	Urologists may request or interpret male pelvic ultrasound focused on bladder and prostate.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N80.0`	Endometriosis of uterus	Pelvic ultrasound can evaluate for endometriomas and associated adnexal masses.
`N83.2`	Torsion of ovary, ovary with fallopian tube	Ultrasound is the primary imaging modality to assess ovarian torsion.
`N92.0`	Excessive and frequent menstruation with regular cycle	Pelvic ultrasound evaluates structural causes of abnormal uterine bleeding.
`N76.0`	Acute vaginitis	Ultrasound may be used to evaluate pelvic pain when infectious causes are suspected.
`N40`	Benign prostatic hyperplasia (BPH)	In male patients, pelvic ultrasound can assess prostate size and post-void residual bladder volume.
`R10.2`	Pelvic and perineal pain	Ultrasound is used to investigate causes of pelvic pain such as ovarian cysts or masses.
`N83.0`	Ovarian cyst, ruptured	Ultrasound is used to detect ovarian cysts and complications such as rupture or hemorrhage.
`N93.9`	Abnormal uterine and vaginal bleeding, unspecified	Pelvic ultrasound helps identify structural etiologies of bleeding.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`76830`	Transvaginal ultrasound, real time with image documentation	Often performed in conjunction with or as an adjunct to pelvic ultrasound for improved visualization of uterus and ovaries.
`76856`	Ultrasound, pelvic (nonobstetric), real-time with image documentation; complete	An alternative code for complete pelvic ultrasound; selection depends on payer definitions and documentation.
`93970`	Duplex scan of extremity veins including responses to compression and other maneuvers	Data not relevant to pelvic ultrasound workflow — included only if venous evaluation is clinically indicated (not typically combined).
`76942`	Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection)	Used when ultrasound guidance is required for pelvic procedures such as aspiration or biopsy performed during the same encounter.
`99000`	Handling and/or conveyance of specimen(s) for transfer from the office to a laboratory	May be used if specimen handling related to an ultrasound-guided procedure occurs during the visit.

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