CPT 76801 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Radiology Procedures • Diagnostic Ultrasound Procedures |
| Common Place of Service | • 11 - Office • 23 - Emergency Room |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 76801 |
National average reimbursement for CPT 76801 by major payers:
$143.68
$146.41
$157.87
$180.23
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 76801 | ||||||
United | 76801 | $100.55 | 1255766531 - MARISSA LIVERIS | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Physician Assistant (363A00000X) |
United | 76801 | $244.32 | 1639558059 - CAROLYN MILLER | 320418835 - UWH OF THE CAROLINAS, PLLC | NC | Obstetrics & Gynecology Physician (207V00000X) |
United | 76801 | $105.61 | 1366438178 - MARK SEIGEL | 454832340 | NJ | Obstetrics & Gynecology Physician (207V00000X) |
United | 76801 | $63.93 | 1801862297 - MARY FINEGAN | 680484083 | CA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76801 | $79.51 | 1437153889 - HARRY RICE | 273645560 - UNIVERSITY OF LOUISVILLE PHYSICIANS INC | KY | Diagnostic Radiology Physician (2085R0202X) |
United | 76801 | $132.61 | 1720341779 - JULIA PHILLIPS | 431771217 - MERCY CLINIC EAST COMMUNITIES | MO | Obstetrics & Gynecology Physician (207V00000X) |
United | 76801 | $144.94 | 1922149525 - ANGELA LANGER | 431704371 - FREEMAN HEALTH SYSTEM | MO | Obstetrics & Gynecology Physician (207V00000X) |
United | 76801 | $120.60 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 76801 | $134.46 | 1922084508 - CHRISTOPHER CHANDLER | 884307716 | NC | Obstetrics & Gynecology Physician (207V00000X) |
United | 76801 | $93.69 | 1346669306 - SARAH TOUT | 204881619 - UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | Obstetrics & Gynecology Physician (207V00000X) |
United | 76801 | $176.80 | 1881771798 - GARY TOIG | 943029453 - GARY S. TOIG, M.D., F.A.C.O.G., SOLE PROPRIETOR | CA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76801 | $298.86 | 1568728681 - SARAH DOTSON | 550492006 - WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION | WV | Obstetrics & Gynecology Physician (207V00000X) |
United | 76801 | $142.40 | 1811000177 - CHARLESTON RADIOLOGISTS PA | 570634747 - CHARLESTON RADIOLOGISTS, P.A. | SC | Single Specialty Group (193400000X) |
United | 76801 | $213.88 | 1588047203 - JENNIFER LICHON | 260609255 - FLORIDA WOMAN CARE, LLC | FL | Obstetrics & Gynecology Physician (207V00000X) |
United | 76801 | $135.80 | 1114119732 - ANIKA MOORE | 272413974 | OH | Obstetrics & Gynecology Physician (207V00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 76801 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76801 code is part of the Radiology Procedures services used for Diagnostic Ultrasound Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 76801 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 76801-CPT | Low | Ultrasound, Pregnant Uterus, Real Time With Image Documentation, Fetal And Maternal Evaluation, First Trimester (< 14 Weeks 0 Days), Transabdominal Approach; Single Or First Gestation |
| 76802-CPT | Low | Ultrasound, Pregnant Uterus, Real Time With Image Documentation, Fetal And Maternal Evaluation, First Trimester (< 14 Weeks 0 Days), Transabdominal Approach; Each Additional Gestation (List Separately In Addition To Code For Primary Procedure) |
| 76805-CPT | Low | Ultrasound Pregnant Uterus Real Time With Image Documentation Fetal And Maternal Evaluation After First Trimester (> Or = 14 Weeks 0 Days) Transabdominal Approach; Single Or First Gestation. (Desc Rev 1/1/03). |
| 76810-CPT | Low | Ultrasound Pregnant Uterus Real Time With Image Documentation Fetal And Maternal Evaluation After First Trimester (> Or = 14 Weeks 0 Days) Transabdominal Approach; Each Additional Gestation (Listseparately In Addition To Code For Primary Procedure Performed (Desc Rev 1/1/03) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76801. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76801 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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