September 5, 2025
Accurate coding of obstetrical ultrasounds ensures proper reimbursement and compliance. CPT code 76815 is a commonly used but often misunderstood code for limited prenatal ultrasounds.
This guide explains when to use 76815, how it differs from similar codes, and key billing guidelines to avoid denials.
CPT code 76815 describes a limited obstetrical ultrasound performed to address a specific clinical concern or follow-up on a known issue. Unlike comprehensive ultrasounds, it does not evaluate full fetal anatomy.
Examples of Use:
Avoid coding errors by understanding how 76815 differs from other obstetric ultrasound codes:
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Need Help? Consult the AMA CPT manual or a certified coder for complex cases.
Optimize your obstetrics coding today! Proper use of CPT 76815 ensures accurate billing and reduces audit risks.
CPT 76815 is used to report a limited obstetrical ultrasound. This exam is typically ordered to evaluate specific aspects of a pregnancy, such as fetal position, placenta location, amniotic fluid, or heartbeat. Unlike a full ultrasound, it does not include a comprehensive anatomical survey.
CPT 76815 is for a partial obstetrical ultrasound, while CPT 76805 represents a complete ultrasound. The complete study involves a thorough examination of fetal anatomy, gestational age, amniotic fluid, and other detailed parameters. The limited code is billed when the physician only evaluates specific, clinically indicated elements.
This code should be billed when a physician orders an ultrasound to check a targeted issue, such as confirming fetal heart activity, assessing placenta placement, or measuring amniotic fluid. It is not appropriate to use 76815 for routine, full evaluations.
Yes, in most cases. Insurance coverage depends on medical necessity and proper documentation. Providers must ensure that the reason for collection the limited ultrasound is clearly documented in the patient’s record.
Providers should include clinical indications, the scope of the exam, findings (e.g., fetal heart rate, amniotic fluid levels), and the physician’s interpretation. Clear documentation supports medical necessity and ensures clean claims submission.
It depends on payer rules. Generally, it should not be billed on the same date as a complete obstetrical ultrasound (CPT 76805) unless there is a separate, distinct clinical reason. Providers should always check payer-specific bundling rules.
Accurate use of CPT 76815 ensures correct reimbursement, reduces claim denials, and maintains compliance with payer guidelines. Misuse of the code can lead to delayed payments or audits.
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