Ultrasound transvaginal
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Bundled with OB ultrasound - should bill OB codes instead
Common76830 (transvaginal ultrasound) is for gynecologic evaluation, not obstetric. If patient is pregnant and ultrasound is for pregnancy dating/evaluation, should bill OB ultrasound codes (76801, 76805, etc.), not 76830. Denials occur when 76830 billed for pregnancy-related imaging.
Common Causes
- • Early pregnancy dating billed as 76830 instead of 76801
- • First trimester pregnancy evaluation using gynecologic code
- • Pelvic ultrasound on pregnant patient - confusion about correct code
Resolution Strategy
Recode to appropriate OB ultrasound code: 76801 (OB, first trimester, single fetus), 76805 (OB, after first trimester, single fetus). If truly gynecologic indication (pelvic pain, abnormal bleeding in non-pregnant patient), appeal with clear non-OB indication.
2. Frequency limit exceeded - too many ultrasounds
CommonTransvaginal ultrasound for fertility monitoring (follicle tracking) may have frequency limits (e.g., 1-2 per month). Payers deny when frequency exceeds policy limits unless medical necessity documented for more frequent monitoring.
Common Causes
- • Infertility treatment - multiple ultrasounds per cycle for follicle monitoring
- • Ovulation induction - frequent imaging to time IUI or intercourse
- • More ultrasounds than payer policy allows per month
Resolution Strategy
Review payer fertility benefit coverage. Many payers limit or exclude fertility treatment coverage including monitoring. Appeal with medical necessity for cycle monitoring if within policy limits. If policy excludes fertility coverage, patient responsibility.
Relative Value Units (RVUs)
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Clinical Information
When to Use
Transvaginal ultrasound (TVUS) for detailed pelvic imaging - superior to transabdominal for uterus, ovaries, early pregnancy
Common Scenarios
Documentation Requirements
- Clinical indication (pelvic pain, bleeding, pregnancy dating)
- Structures visualized (uterus, ovaries, adnexa, cul-de-sac)
- Measurements obtained (endometrial thickness, gestational sac if pregnant, ovarian cysts)
- Radiologist or physician interpretation
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes complete pelvic evaluation - uterus, ovaries, adnexa
- Cannot bill with transabdominal pelvic ultrasound (76856) unless separate clinical indication documented
- If OB ultrasound for pregnancy, use OB ultrasound codes (76801, 76805, etc.) not 76830
Exclusions
- Do not bill for pregnancy dating after first trimester (use OB ultrasound codes)
- Cannot bill both transvaginal and transabdominal pelvic US same encounter without medical necessity
- Follicle monitoring during fertility treatment may have frequency limits
Coding Notes
Clinical scenarios
- Clinical indication (pelvic pain, bleeding, pregnancy dating)
- Structures visualized (uterus, ovaries, adnexa, cul-de-sac)
- Measurements obtained (endometrial thickness, gestational sac if pregnant, ovarian cysts)
- Clinical indication (pelvic pain, bleeding, pregnancy dating)
- Structures visualized (uterus, ovaries, adnexa, cul-de-sac)
- Measurements obtained (endometrial thickness, gestational sac if pregnant, ovarian cysts)
- Clinical indication (pelvic pain, bleeding, pregnancy dating)
- Structures visualized (uterus, ovaries, adnexa, cul-de-sac)
- Measurements obtained (endometrial thickness, gestational sac if pregnant, ovarian cysts)
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 76830 is the billing code for "Ultrasound transvaginal". Transvaginal ultrasound (TVUS) for detailed pelvic imaging - superior to transabdominal for uterus, ovaries, early pregnancy
Medicare pays approximately $114.18 for CPT 76830 (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 76830 has a total RVU of 6.89, broken down as: Work RVU 1.26, Practice Expense RVU 5.32, and Malpractice RVU 0.31. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 76830 is "Bundled with OB ultrasound - should bill OB codes instead". 76830 (transvaginal ultrasound) is for gynecologic evaluation, not obstetric. If patient is pregnant and ultrasound is for pregnancy dating/evaluation, should bill OB ultrasound codes (76801, 76805, etc.), not 76830. Denials occur when 76830 billed for pregnancy-related imaging. Common causes include: Early pregnancy dating billed as 76830 instead of 76801; First trimester pregnancy evaluation using gynecologic code. Appeal success rate is approximately 10-30%.
Key documentation requirements for CPT 76830 include: Clinical indication (pelvic pain, bleeding, pregnancy dating); Structures visualized (uterus, ovaries, adnexa, cul-de-sac); Measurements obtained (endometrial thickness, gestational sac if pregnant, ovarian cysts); Radiologist or physician interpretation. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 76830: Includes complete pelvic evaluation - uterus, ovaries, adnexa. Cannot bill with transabdominal pelvic ultrasound (76856) unless separate clinical indication documented Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 76830 include: 26 (Professional component (physician interpretation)), TC (Technical component (facility/equipment)). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 76830 is 20-30 minutes for exam and documentation. Time-based codes require documentation of the actual time spent providing the service.