Ultrasound, pregnant uterus, complete

CPT 76805 is the billing code for "Ultrasound, pregnant uterus, complete". For complete ultrasound of pregnant uterus

Medicare pays approximately $130.03 for CPT 76805 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 76805 has a total RVU of 4.49, broken down as: Work RVU 0.90, Practice Expense RVU 3.50, and Malpractice RVU 0.09. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 76805 include: Indication for prenatal ultrasound; Complete fetal evaluation; Fetal measurements; Findings and interpretation. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 76805: Includes complete pregnant uterus ultrasound. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 76805 include: 26 (Professional component only (interpretation)), TC (Technical component only (equipment/staff)), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 76805 is 30-45 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.