Ultrasound, pelvic (nonobstetric), limited

CPT 76857 is the billing code for "Ultrasound, pelvic (nonobstetric), limited". For limited pelvic ultrasound (nonobstetric)

Medicare pays approximately $48.52 for CPT 76857 (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 76857 has a total RVU of 2.50, broken down as: Work RVU 0.45, Practice Expense RVU 2.00, and Malpractice RVU 0.05. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 76857 include: Indication for limited pelvic ultrasound; Area(s) imaged; Findings and interpretation; Comparison to prior studies if available. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 76857: Includes limited pelvic ultrasound. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 76857 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 76857 is 10-20 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.