CPT Code 76801 Guide to Limited Obstetrical Ultrasounds

CPT Code 76801 is used to report a complete obstetrical ultrasound performed in the first trimester of pregnancy. It includes a detailed evaluation of the uterus, gestational sac, embryo/fetus, crown-rump length, yolk sac, and maternal adnexa (ovaries and surrounding structures), including Trans abdominal or transvaginal approach.

Even though some confusion, CPT 76801 is for a whole obstetric ultrasound in the first trimester. If only a limited assessment is done (e.g., fetal heartbeat or position), CPT 76815 is the correct code. Choosing the right code depends on the scope of the exam and documentation.

• Use 76801 for a whole first-trimester ultrasound via the Trans abdominal methodology.
• Use 76817 for a transvaginal ultrasound typically performed in early pregnancy or to assess issues like bleeding.
  Sometimes both are performed in the same session; in that case, documentation must support the use of both codes with appropriate modifiers (e.g., modifier 59).

Yes, CPT 76801 is typically covered by insurance and Medicare when medically necessary and properly documented. It must meet clinical indications like dating the pregnancy, confirming viability, or evaluating suspected ectopic pregnancy. Always check the payer’s coverage policy and include relevant ICD-10 codes such as Z34.80 (Encounter for supervision of normal pregnancy).

Generally, 76801 is billed only once per pregnancy for the first-trimester evaluation. For follow-up or repeat ultrasounds, providers should use codes like 76815 (limited) or 76816 (follow-up). Repeating 76801 without clinical necessity may result in claim denials or payer audits.

To support billing CPT 76801, providers must include:

• Gestational sac evaluation
• Fetal heartbeat presence
• Crown-rump length or gestational age estimation
• Maternal adnexa assessment
• Uterus and cervix evaluation
  the report should specify the type of ultrasound (Trans abdominal/transvaginal) and clearly state the findings. Accurate and complete documentation is essential for compliance and reimbursement.