Ultrasound, pregnant uterus, detailed fetal anatomic examination

CPT 76811 is the billing code for "Ultrasound, pregnant uterus, detailed fetal anatomic examination". For detailed fetal anatomic examination ultrasound

Medicare pays approximately $172.08 for CPT 76811 (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 76811 has a total RVU of 5.82, broken down as: Work RVU 1.20, Practice Expense RVU 4.50, and Malpractice RVU 0.12. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 76811 include: Indication for detailed fetal ultrasound; Detailed fetal anatomic examination; All fetal structures documented; Fetal measurements. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 76811: Includes detailed fetal anatomic examination. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 76811 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 76811 is 45-60 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.