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CPT 76805 Explained Mastering First-Trimester Ultrasound Billing

Name: Cures Medical Billing Services Company
Address: 3811 Ditmars Blvd# 1124, Astoria, NY 11105, Astoria, NY, 11105, USA
Telephone: +1 (917) 994-9941

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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We are a team of national medical billing service experts based in Astoria, NY, committed to providing ongoing value to our customers. We leverage technology and implement best practices to provide high-quality and cost-efficient medical billing solutions from domestic locations, enabling customers to achieve their business goals. Cures Medical Billing is the best option for any medical billing needs.

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