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CPT 76805 Explained Mastering First-Trimester Ultrasound Billing

A professional take altrasound of women in lab professional use CPT 76805 for billing.

Accurate coding for fetal ultrasounds is essential for OB/GYN practices, and CPT 76805 is one of the most commonly used and misunderstood codes.

Whether you’re a coder, biller, or provider, this guide breaks down everything you need to know about CPT 76805, including documentation requirements and billing rules.

What Is CPT 76805?

CPT 76805 refers to a Trans abdominal or transvaginal ultrasound performed during the first trimester (6–14 weeks) to:

  • Confirm pregnancy viability.
  • Determine gestational age.
  • Identify the number of embryos/fetuses.
  • Assess the uterus and adnexa.

Key Documentation Requirements

  • Measurement of fetal crown-rump length.
  • Evaluation of fetal cardiac activity.
  • Notation of placental location (if visible).

When to Use CPT 76805 vs. Other Codes

  • CPT 76805 vs. 76813: Use 76805 for basic viability scans; 76813 applies only when a nuchal translucency measurement is performed for chromosomal screening.
  • CPT 76805 vs. 76817: 76805 is for first-trimester scans, while 76817 is a follow-up anatomical exam in later trimesters.

Can you bill 76805 with other codes?

  • With 76813: Yes, if both a viability scan and nuchal translucency screening are performed.
  • With 76817: Rarely, since they apply to different trimesters. Use modifier 59 if justified by separate medical necessity.

3 Mistakes That Trigger Denials for CPT 76805

  • Incorrect trimester timing: 76805 is strictly for 6–14 weeks.
  • Missing cardiac activity documentation: Failure to note fetal heartbeat leads to denials.
  • Bundling with 76813 without medical necessity: Payers may reject claims if both codes lack clear justification.

Final Tips to Optimize CPT 76805 Billing

  • Always confirm gestational age with crown-rump length.
  • Use structured templates for ultrasound reports to ensure compliance.
  • Audit charts regularly to catch documentation gaps.

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FAQs about CPT 76805

Yes! The code includes evaluation of multiple gestations. Document each fetus’s cardiac activity and measurements.

No. Doppler assessments (e.g., umbilical artery) require CPT 76818 or 76819.

  • Modifier 59: If performed with another distinct service (e.g., 76813).
  • Modifier 76: For repeat ultrasounds by the same provider.
  • Yes! Link the code to diagnoses like ICD-10 Z34.01 (routine first-trimester pregnancy) or O09.521 (high-risk pregnancy).

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