Ultrasound, pelvic (nonobstetric), complete

CPT 76856 is the billing code for "Ultrasound, pelvic (nonobstetric), complete". For complete pelvic ultrasound (nonobstetric)

Medicare pays approximately $101.57 for CPT 76856 (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 76856 has a total RVU of 3.77, broken down as: Work RVU 0.70, Practice Expense RVU 3.00, and Malpractice RVU 0.07. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 76856 include: Indication for pelvic ultrasound; Complete pelvic evaluation; All pelvic organs documented; Findings and interpretation. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 76856: Includes complete pelvic ultrasound. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 76856 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 76856 is 20-30 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.