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 2014. 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.
|2014 Medicare Physician Fee Schedule – National Average*|
|CPT Code||Description||Non Facility1||Facility2||Professional Payment3||Technical Payment4|
|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||$127.89||$127.89||$49.79||$78.09|
|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)||$68.06||$68.06||$42.27||$25.79|
|76805||U/S, Pregnant uterus, fetal and maternal evaluation, > 1st trimester—trans abdominal; single of first gestation.||$147.95||$147.95||$50.15||$97.80|
|76810||Each additional gestation (list separately in addition to code for primary procedure)||$98.15||$98.15||$49.79||$48.36|
|76811||U/S, Pregnant uterus, fetal and maternal evaluation plus detailed fetal anatomic exam—trans abdominal; single or first gestations||$187.35||$187.35||$96.72||$90.63|
|76812||Each additional gestation (list separately in addition to code for primary procedure)||$212.43||$212.43||$90.99||$121.44|
|76813||U/S, Pregnant uterus, 1st trimester fetal nuchal translucency measurement—transabdominal or transvaginal approach, single or first gestation||$122.51||$122.51||$60.18||$62.33|
|76814||Each additional gestation (list separately in addition to code for primary procedure)||$80.60||$80.60||$50.51||$30.09|
|76815||U/S, Pregnant uterus, limited (fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), one or more fetuses||$91.35||$91.35||$32.50||$58.75|
|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||$117.86||$117.86||$43.35||$74.51|
|76817||U/S pregnant uterus—transvaginal||$102.81||$102.81||$38.33||$64.48|
|76818||Fetal Biophysical Profile||$123.59||$123.59||$53.73||$64.48|
|76819||Fetal biophysical profile; without non-stress testing||$90.63||$90.63||$39.41||$51.23|
|76820||Doppler velocimetry, fetal; umbilical artery||$49.44||$49.44||$25.43||$24.00|
|76831||Hysterosonography, with or without color flow Doppler||$125.38||$125.38||$36.90||$88.48|
|76856||Ultrasound, pelvic (non-obstetric), real time with image documentation; complete||$125.74||$125.74||$34.75||$90.99|
|76857||Limited or follow-up (e.g., for follicles)||$54.45||$54.45||$19.34||$35.11|
|76941||U/S guidance for intrauterine fetal transfusion or cordocentesis, imaging supervidion and interpretation||n/a||n/a||$70.93||n/a|
|76942||Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation||$74.15||$74.15||$34.03||$40.12|
|76945||U/S guidance for chorionic villus sampling, imaging supervision and interpretation||n/a||n/a||$35.11||n/a|
|76946||U/S guidance for amniocentesis, imaging supervision and interpretation||$32.60||$32.60||$19.34||$13.25|
|76948||U/S guidance for aspiration of ova, imaging supervision and interpretation||$33.32||$33.32||$20.06||$13.25|
1Non Facility: use to estimate services in the physician officee setting.
2Facility: use to estimate services in the hospital (inpatient, outpatient, and emergency department), ambulatory surgical centers (ASCs), and skilled nursing facilities (SNFs).
3Professional Payment: use to estimate the reimbursement to the physician.
4Technical Payment: use to estimate the reimbursement to the technologist.
CPT™ five digit codes, nomenclature and other data are Copyright 2013 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.
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