Women's Health Payment Information

The following chart provides payment information that is based on the national unadjusted Medicare physician fee schedule for the ultrasound services discussed. Payment will vary by geographic region.

The information provided below is intended to assist providers in determining appropriate codes and the other information for reimbursement purposes. It represents the information available to United Medical Instruments as of January 2012. Subsequent guidance might alter the information provided. United Medical Instruments disclaims any responsibility to update the information provided. It is the provider’s responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current requirements and policies with the applicable payer.

Breast Surgery Ultrasound and Procedural CPT Codes and Descriptions

Ultrasound Evaluation

2012 Medicare Physician
Fee Schedule
CPT Code
 Code Description Global in Office Allowable
76645 Ultrasound, breast(s) (unilateral or bilateral), real time with image documentation $99.39
76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation $206.61

Procedures

2012 Medicare Physician Fee Schedule 
CPT Code
 Code Description Global in Office Allowable
10022

Fine needle aspiration; with imaging guidance

 $136.83
19000 Puncture aspiration of cyst of breast $109.94
19102 Biopsy of breast, percutaneous, needle core, using imaging guidance $212.05
19103 Biopsy of breast, percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance $548.35
19290 Preoperative placement of needle localization wire, breast $159.64
19295 Image guided placement of metallic localization clip or marker during biopsy $91.22
60100 Biopsy, thyroid, percutaneous core needle $110.96

Women's Health Ultrasound and Procedural CPT Codes and Descriptions

Ultrasound Evaluation

2012 Medicare Physician Fee Schedule
CPT Code
 Code Description

Global in Office Allowable
76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester ( 14 weeks 0 days), transabdominal approach; single or first gestation $131.73
76802 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester ( 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) $69.44
76805 U/S, Pregnant uterus, fetal and maternal evaluation, > 1st trimester—trans abdominal; single of first gestation. $152.49
76810 Each additional gestation (list separately in addition to code for primary procedure) $99.73
76811 U/S, Pregnant uterus, fetal and maternal evaluation plus detailed fetal anatomic exam—trans abdominal; single or first gestations $193.33
76812 Each additional gestation (list separately in addition to code for primary procedure) $213.08
76813 U/S, Pregnant uterus, 1st trimester fetal nuchal translucency measurement—transabdominal or transvaginal approach, single or first gestation $127.98
76814 Each additional gestation (list separately in addition to code for primary procedure) $82.37
76815 U/S, Pregnant uterus, limited (fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), one or more fetuses $93.26
76816 U/S, Pregnant uterus, follow-up (re-eval of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system (s)) suspected or confirmed to be abnl on previous scan), transabdominal approach, per fetus $121.85
76817 U/S pregnant uterus—transvaginal $105.18
76818 Fetal Biophysical Profile $125.60
76819 Fetal biophysical profile; without non-stress testing $92.92
76820 Doppler velocimetry, fetal; umbilical artery $44.25

Non-Obstetric Ultrasound Evaluation

2012 Medicare Physician Fee Schedule
CPT Code
 Code Description

Global in Office Allowable
76830 U/S, Transvaginal $129.00
76831 Hysterosonography, with or without color flow Doppler $130.36
76856 Ultrasound, pelvic (non-obstetric), real time with image documentation; complete                                            $127.64
76857 Limited or follow-up (e.g., for follicles) $101.09

Procedures

2012 Medicare Physician Fee Schedule
CPT Code
 Code Description

Global in Office Allowable
76941 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); follow-up or limited study (List separately in addition to codes for echocardiographic imaging) N/A
76942 Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) $206.61
76945 U/S quidance for chorionic villus sampling, imaging supervision and interpretation N/A
76946 U/S guidance for amniocentesis, imaging supervision and interpretation $35.40
76948 U/S guidance for aspiration of ova, imaging supervision and interpretation $38.73


CPT™ five digit codes, nomenclature and other data are Copyright 2010 American Medical Association. All rights reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

Deficit Reduction Act of 2005 Adjustment has not been figured into the above global fees.