2015 OB/GYN 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 2015. 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.

OB/GYN Ultrasound and Procedural CPT Codes and Descriptions

2015 Medicare Physician Fee Schedule – National Average*
Ultrasound Evaluation    
CPT Code Description Private Office 1 Hospital 2 Professional  Component 3 Technical Component4
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 $125.86 $125.86 $52.20 $73.65
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) $66.50 $66.50 $43.62 $22.88
76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation $144.45 $144.45 $52.20 $92.25
76810 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) $96.18 $96.18 $51.84 $44.34
76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation $184.49 $184.49 $100.47 $84.02
76812 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) $209.16 $209.16 $94.75 $114.42
76813 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation $123.35 $123.35 $62.57 $60.78
76814 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (List separately in addition to code for primary procedure) $82.95 $82.95 $52.56 $30.39
CPT Code Description  
76815 Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses $85.81 $85.81 $33.97 $51.84
76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus $116.56 $116.56 $44.69 $71.87
76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal $98.68 $98.68 $39.33 $59.35
76818 Fetal biophysical profile; with non-stress testing $123.35 $123.35 $55.78 $67.58
76819 Fetal biophysical profile; without non-stress testing $90.10 $90.10 $40.40 $49.70
76820 Doppler velocimetry, fetal; umbilical artery $47.90 $47.90 $26.10 $21.81
Non-Obstetric Ultrasound Evaluation    
CPT Code Description Private Office 1 Hospital 2 Professional  Component 3 Technical Component4
76830 Ultrasound, transvaginal $123.71 $123.71 $35.75 $87.96
76831 Saline infusion sonohysterography (SIS), including color flow Doppler, when performed $120.14 $120.14 $37.90 $82.24
76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete $110.84 $110.84 $34.68 $76.16
76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) $47.55 $47.55 $24.67 $22.88
Procedures    
CPT Code Description Private Office 1 Hospital 2 Professional  Component 3 Technical Component4
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation $60.78 $60.78 $33.61 $27.17
76946 Ultrasonic guidance for amniocentesis, imaging supervision and interpretation $33.25 $33.25 $20.02 $13.23
76948 Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation $33.25 $33.25 $20.02 $13.23

1Private Office = Non Facility: use to estimate services in the physician officee setting. 
2Hospital = Facility: use to estimate services in the hospital (inpatient, outpatient, and emergency department), ambulatory surgical centers (ASCs), and skilled nursing facilities (SNFs). 
3
Professional Payment: use to estimate the reimbursement to the physician.

4Technical Payment: use to estimate the reimbursement to the technologist.

CPT™ ve 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.