CPT Code 76817 Guide to Transvaginal Ultrasound Coding

A professional men and women get Transvaginal Ultrasound doctor use code for billing CPT Code 76817 .

Key Takeaways

  • CPT 76817 – Transvaginal ultrasound for obstetric purposes (first trimester, cervical length, fetal evaluation).
  • Do not confuse with 76830, which is non-obstetric.
  • Always document medical necessity + images to support claims.
  • Use modifiers (-26, -59, -TC) appropriately to avoid denials.
  • Pair with the correct ICD-10 codes to match the clinical scenario.

Navigating ultrasound billing can be tricky, especially when differentiating between CPT code 76817 and similar pelvic or abdominal ultrasound codes like 76830. This guide breaks down the 76817 CPT code description, usage, and billing rules to help providers avoid denials and maximize reimbursement.

What Is CPT Code 76817?

CPT code 76817 is used for:
Ultrasound, pregnant uterus, real-time with image documentation, transvaginal.

  • Procedure: A transducer is inserted into the vagina to obtain images of the uterus, fetus (if pregnant), cervix, and adnexal structures.
  • Common Uses:
    • Early pregnancy assessments (location of gestational sac, ectopic pregnancy evaluation).
    • Cervical length measurements in high-risk pregnancies.
    • Evaluating abnormal bleeding or pelvic pain.
    • Detecting ovarian cysts, uterine anomalies, or fibroids.

Key elements for billing 76817

  • Requires image documentation and a detailed report.
  • Medical necessity must be clear (e.g., ICD-10 codes like N93.9 for abnormal bleeding).

CPT 76817 vs. CPT 76830

One of the most common mistakes in billing is confusing 76817 (obstetric transvaginal) with 76830 (non-obstetric transvaginal ultrasound).

Code

Description

Typical Use

76817

Transvaginal ultrasound, pregnant uterus

Obstetric purposes (first-trimester pregnancy, cervical length check, fetal assessment)

76830

Transvaginal ultrasound, non-obstetric

Gynecological purposes (pelvic pain, ovarian cysts, uterine fibroids, abnormal bleeding)

Key tip: Always link the correct ICD-10 code (pregnancy-related vs. non-pregnancy-related) to avoid denials.

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Related Ultrasound CPT Codes

Billing Guidelines for CPT Code 76817

  • Medical Necessity
    Document why the transvaginal approach was required (e.g., suspected ectopic pregnancy, pelvic mass, cervical evaluation).
  • Image Documentation
    Save and store images in the patient record; lack of documentation often leads to claim denials.
  • Modifiers
    • -26: Professional component only
    • -TC: Technical component only
    • -59: When billed with another ultrasound (e.g., 76801 + 76817 for ectopic pregnancy evaluation)
  • Bundling Rules
    Some payers may bundle 76817 with abdominal ultrasound codes. Use modifiers when appropriate to separate services.
  • Not for Routine Screening
    Do not use 76817 for routine prenatal careβ€”reserve it for diagnostic imaging.

Final Thoughts

CPT code 76817 plays a crucial role in early pregnancy and pelvic diagnostics. Clear documentation, proper modifier use, and payer-specific compliance help providers secure correct reimbursement and reduce audit risks.

Need expert help with OB/GYN ultrasound billing? Contact Cures Medical Billing today for error-free claims and maximized reimbursements.

Frequently Asked Questions (FAQs)

CPT 76817 is used for transvaginal ultrasound during pregnancy to evaluate the uterus, cervix, and fetus in early gestation.

Yes, CPT 76817 is generally covered by insurance when medically necessary, such as for evaluating early pregnancy, fetal viability, or gynecologic issues. Always verify payer-specific policies.

  • 76817: Obstetric transvaginal ultrasound (pregnancy-related).
  • 76830: Non-obstetric transvaginal ultrasound (gynecologic).

Yes, if both exams are medically necessary (e.g., abdominal + transvaginal for ectopic pregnancy). Use modifier -59 to prevent bundling issues.

Reimbursement varies by location and payer, but the national average is between $85–$130 for professional and technical components combined. Always check the current CMS fee schedule.

Common modifiers include:

  • -TC (technical component)
  • -26 (professional component)
  • -59 (distinct service, if billed with other ultrasound codes)
  • Use them based on billing structure and service location.

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No. For non-obstetric pelvic imaging, bill CPT 76830 instead.

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