October 9, 2025
CPT Code 76801 is the billing code used for a complete transabdominal pregnancy ultrasound. This code applies when a provider performs a detailed evaluation of the uterus, gestational sac, embryo/fetus, adnexa, and pelvic structures during the first trimester of pregnancy.
In 2025, correct documentation of CPT 76801 is more critical than ever due to payer audits, compliance checks, and the rise of AI-driven claim scrubbing systems. Healthcare providers and billing managers need to understand when and how to use this code to ensure proper reimbursement and avoid denials.
CPT 76801 refers to a limited ultrasound of the pregnant uterus to assess specific, immediate concerns. It’s not a comprehensive exam and is often used for:
According to the AMA CPT guidelines, 76801 is defined as:
Ultrasound, pregnant uterus, real-time with image documentation, fetal and maternal evaluation, first trimester (less than 14 weeks 0 days), transabdominal approach; single or first gestation.
This code covers a complete first-trimester ultrasound, not a limited or follow-up exam.
You should report CPT 76801 when:
Common Scenarios:
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Understanding the differences between related codes prevents denials and duplicate billing:
Tip: Providers often ask, “Can CPT 76801 and 76817 be billed together?” The answer: Yes, but only if both transabdominal (76801) and transvaginal (76817) studies are performed for a distinct medical necessity. Documentation must clearly support both.
To avoid denials, documentation should include:
For clinical best practices on pregnancy ultrasounds, you can review the official ACOG obstetric ultrasound guidelines. These recommendations help providers align with the latest standards of maternal-fetal care.
For up-to-date reimbursement rates and compliance rules, the CMS Physician Fee Schedule offers authoritative details on coverage and payment policies for CPT code 76801 and related procedures.
Understanding CPT Code 76801 is vital for accurate pregnancy ultrasound billing and compliance in 2025. With the right documentation, awareness of related codes like 76817 and 76813, and updated knowledge of payer requirements, providers can avoid denials and ensure proper reimbursement.
Cures Medical Billing specializes in simplifying complex OB/GYN and ultrasound billing. Our team ensures accurate claim submission, compliance with the latest coding updates, and maximum reimbursement for healthcare providers.
Whether you’re dealing with denials, modifiers, or payer-specific rules, Cures Medical Billing has the expertise to handle it all, so you can stay focused on patient care.
Contact Cures Medical Billing today to streamline your ultrasound billing and secure faster payments.
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.
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:
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