In the ever-evolving world of medical billing, correctly identifying and documenting ultrasound procedures is critical, not only for accurate reimbursement but also for compliance and patient care. Among the most frequently used codes in prenatal care is CPT Code 76805.
Whether you’re a healthcare provider, billing specialist, or clinic administrator, this guide will walk you through what CPT Code 76805 means, how it differs from related codes like 76811, and why documentation matters more than ever.
CPT Code 76805 refers to a complete obstetric ultrasound typically performed after the first trimester of pregnancy. It includes:
This is a comprehensive scan, commonly ordered between 18–22 weeks of gestation to monitor fetal development and screen for anomalies.
76805 – Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after the first trimester (≥14 weeks 0 days), trans abdominal approach; single or first gestation.
This code includes both maternal and fetal evaluation, making it distinct from limited scans like CPT Code 76815.
Accurate documentation is essential. Here’s what should be included:
Billing errors related to CPT Code 76805 usually occur due to missing components or incorrect use when a limited scan (like 76815) was performed.
The 76805 CPT code cost can vary based on provider type, location, and whether the service is hospital-based or performed in an outpatient setting. On average:
If your practice handles out-of-network or uninsured patients, it’s wise to pre-authorize and communicate costs upfront.
What is the difference between CPT Code 76805 and 76811?
Here’s the breakdown:
Feature | 76805 – Complete OB Scan | 76811 – Detailed Fetal Anatomical Exam |
Complexity | Standard complete anatomy scan | High-risk, detailed evaluation |
Indication | Routine evaluation | Suspected anomaly or maternal risk |
Level of detail | Standard fetal anatomy | Detailed organ/system review |
Specialist required? | No | Often interpreted by an MFM specialist |
If you bill 76811 when only a standard scan was performed, it could result in denials or audits. Proper documentation and clinical indication are crucial
We often find that new staff confuse CPT Code 76805 with 76815, especially in busy OB/GYN clinics. To avoid billing rejections, train front desk and sonographers to flag the scan type and gestational age clearly during intake.
Stephanie R., Billing Supervisor at CuresMB
Always match the CPT code with the clinical intent and scan findings to avoid denials.
Understanding CPT Code 76805 and using it correctly is vital for both financial health and patient care quality. Mismanagement or mistake between 76805, 76811, or 76815 can lead to claim denials, revenue leakage, or compliance risks.
As medical billing specialists, we help clinics streamline their ultrasound coding by offering:
Need help getting your OB ultrasound billing right?
Let our certified coders optimize your CPT coding and improve claim success rates.
Contact us today for a free audit of your ultrasound claims.
CPT Code 76805 includes a full obstetric ultrasound typically performed after the first trimester. It covers a thorough fetal anatomy scan, placental position, fetal measurements (like head and femur length), and an evaluation of the mother’s uterus and ovaries. Think of it as a routine but detailed “check-in” on both mom and baby during mid-pregnancy.
Use 76805 when performing a full scan with comprehensive details on fetal and maternal structures. 76815, on the other hand, is for limited scans—such as checking fetal heartbeat or fluid levels in urgent or follow-up cases. If you’re ever unsure, ask: “Did we look at the whole anatomy or just one aspect?” That usually clarifies the right code.
To bill CPT Code 76805 properly, you need to document:
Gestational age
Purpose of the scan
All anatomy reviewed
Images captured and reviewed by a physician
Providers often forget to note whether all required structures were evaluated, which is key for compliance and reimbursement. By a checklist can help reduce missed details.
Yes, most insurance plans—including Medicaid and Medicare—cover CPT Code 76805 as part of standard prenatal care, especially when it’s performed within the recommended gestational window. Still, coverage can vary slightly by state or provider network, so pre-authorization or benefit checks are always a smart move.
While both involve fetal anatomy scans, 76805 is a standard, routine exam for pregnancy monitoring. 76811 is more detailed and used for high-risk pregnancies where there’s concern for abnormalities or complications. Think of 76805 as general prenatal care and 76811 as a deeper dive when something more complex is suspected.
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