CPT 76805: obstetric ultrasound after the first trimester
76805 reports a standard obstetric ultrasound at 14 weeks or later with a single fetus. It is billed outside the global obstetric package, as one unit, and it can be billed whole or split into a professional and a technical component depending on who owns the equipment.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 76805 is the standard obstetric scan for a single fetus at 14 weeks or later. The NCCI manual says ultrasound is not part of the global obstetric package, so it is billed on its own line. The fee schedule file allows modifiers 26 and TC, and the MUE is 1 per date.
What does CPT 76805 report?
76805 reports a standard, real-time obstetric ultrasound of a pregnancy at 14 weeks or later with a single fetus. The October 2026 fee schedule file labels it "Ob us >/= 14 wks sngl fetus" and gives it status A, so Medicare pays it under the fee schedule when covered.
| Item | Value |
|---|---|
| Payment status | A (active, paid under the fee schedule if covered) |
| PC/TC indicator | 1 (diagnostic test; modifiers 26 and TC can be used) |
| Global period | XXX |
| Work RVU | 0.97 |
| Total RVU, global / 26 / TC | 4.07 / 1.41 / 2.66 |
| Facility NA indicator | NA (rarely or never performed in the facility setting) |
| Practitioner MUE, Q4 2026 | 1 per date, indicator 2, rationale code descriptor |
An MAI of 2 is an absolute per-day edit based on policy (NCCI Chapter I). A second fetus is not reported as a second unit of 76805, as the next section shows.
Which obstetric ultrasound code fits the scan?
The scan type, the gestational age and the number of fetuses pick the code. The fee schedule labels show the family around 76805, with the total RVU for each global code.
| Code | Fee schedule label, paraphrased | Total RVU (global) | MUE (Q4 2026) |
|---|---|---|---|
| 76801 | Under 14 weeks, single fetus | 3.50 | 1 |
| 76805 | 14 weeks or later, single fetus | 4.07 | 1 |
| 76810 | 14 weeks or later, each additional fetus (add-on) | 2.65 | 2 |
| 76811 | Detailed scan, single fetus | 5.45 | 1 |
| 76815 | Limited scan | 2.44 | 1 |
| 76816 | Follow-up scan, each fetus | 3.33 | 2 |
| 76817 | Transvaginal obstetric scan | 2.78 | 1 |
76810 has a global period of ZZZ, which the file defines as a code always related to another service, so it is an add-on code that goes with 76805 and not alone. For twins, bill 76805 once and 76810 for the second fetus.
How do you bill a scan with a prenatal visit or the global package?
Bill the scan on its own line, outside the package. NCCI Policy Manual Chapter VII, section G.1, says the total obstetrical packages, 59400 and 59510, do not include ultrasound, amniocentesis, special screening tests for genetic disorders, visits for unrelated conditions, or additional frequent visits due to high-risk conditions. See 59400 and 59510 for the package side.
The routine prenatal visit on the same day is not billed, since it is inside the package. A visit for an unrelated condition is outside it and can be billed with modifier 25 when it is significant and separately identifiable.
A group provides all of a patient's care. At 22 weeks she has her routine prenatal visit and a scan. The claim for that day carries 76805 with 1 unit and no visit line. The delivery later is billed with 59400, which also does not include the scan.
When do you bill the whole scan and when only one component?
Bill the global code, with no modifier, when your office owns the equipment and your physician reads the scan. Use modifier 26 when your physician only interprets a scan in a facility, and modifier TC when you bill only the technical side. The file's PC/TC indicator of 1 makes both modifiers valid, and the two components add up to the global value: 1.41 plus 2.66 is 4.07.
Chapter 26, item 24B, requires a place of service on every line. A registered outpatient of a hospital is POS 22 on campus or POS 19 off campus, and an inpatient is POS 21. Radiology groups can see more on radiology billing.
What fields hold 76805 and the fetal count?
An obstetric ultrasound line carries 76805 in Item 24D and 1 unit in Item 24G for a single fetus. Item 24E points to the pregnancy diagnosis in Item 21, and the weeks of gestation belong in the report. If the practice owns the equipment and reads the scan, the global line has no modifier.
RVU26D marks 76805 as status A with global XXX, and the MUE table limits it to 1 per date with indicator 2, a policy edit.
Example: A patient at 22 weeks has the anatomy scan on 10/15. The line reads 76805, pointer A (Z34.02), 1 unit, $215.00. Check the fetal count in the report against the code before billing. A missing pointer returns the line as incomplete under CO-16, and a pointer that does not support a scan can draw CO-11.
Why does a 76805 claim deny?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated | A payer that treats the scan as part of the global package, against NCCI Chapter VII, section G.1 |
| 151 | Payment adjusted because the payer deems the information submitted does not support this many/frequency of services | More scans in the pregnancy than the payer allows without an indication |
| 50 | These are non-covered services because this is not deemed a 'medical necessity' by the payer | A routine scan with no documented indication |
| 11 | The diagnosis is inconsistent with the procedure | A pregnancy scan billed with no pregnancy diagnosis on the line |
If these denials keep coming back, our denial management team can work them.
Related codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- 2026 NCCI Medicare Policy Manual, Chapter I: General Correct Coding Policies · CMS
- 2026 NCCI Medicare Policy Manual, Chapter VII: Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Claim Adjustment Reason Codes · X12
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Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01How do I bill an OB ultrasound with a visit?
Bill 76805 on its own line, because the NCCI manual says ultrasound is outside the global package. A routine prenatal visit that day is part of the package and is not billed. A visit for an unrelated condition is billed with modifier 25 and separate documentation.
02Is 76805 part of the global OB package?
No. NCCI Policy Manual Chapter VII, section G.1, says the total obstetrical packages, 59400 and 59510, do not include ultrasound, amniocentesis or special genetic screening tests. Bill 76805 as a separate line with the date of the scan, and one unit.
03How do I bill a scan of twins?
Bill 76805 once for the first fetus and the add-on 76810 for the additional fetus. The October 2026 file gives 76810 a ZZZ global period, which marks it as always related to another service. Its MUE is 2 per date, and 76805 stays at 1.
04When do I use modifier 26 or TC with 76805?
Use 26 when you bill only the physician's interpretation, and TC when you bill only the technical component. Bill neither when you provide both. The fee schedule gives 76805 PC/TC indicator 1, and the global total of 4.07 RVUs splits into 1.41 professional and 2.66 technical.
05How many units of 76805 can I bill?
One per date of service. The practitioner MUE for the fourth quarter of 2026 is 1 with indicator 2, an absolute edit based on policy. For a second fetus, the add-on code 76810 is used, not a second unit of 76805.
Obstetric scans denied as part of the package?
We check the scan line, component modifiers and package codes together before the claim goes out.