CPT 76802 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 76802 by major payers:
$75.84
$79.45
$83.47
$95.78
| 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 76802 | ||||||
United | 76802 | $118.69 | 1285038059 - SWATHI CHALLA | 440605373 - CHILDRENS MERCY HOSPITAL | MO | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76802 | $85.47 | 1265630735 - GLORIA DIAZ-MEDINA | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | FL | Epilepsy Physician (2084E0001X) |
United | 76802 | $158.11 | 1093281164 - SARA ROLLINS | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Neonatal Nurse Practitioner (363LN0000X) |
United | 76802 | $85.47 | 1659682201 - TASHA BRYANT | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Family Nurse Practitioner (363LF0000X) |
United | 76802 | $95.08 | 1851711857 - SARA JACOBS | 741613878 - (TX) BAYLOR COLLEGE OF MEDICINE | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76802 | $85.47 | 1811936941 - ERIK SHULTZ | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Obstetrics & Gynecology Physician (207V00000X) |
United | 76802 | $85.47 | 1336316074 - VENEE TUBMAN | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | 76802 | $221.38 | 1467169862 - MADISON CARTER | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Medical Physician Assistant (363AM0700X) |
United | 76802 | $85.47 | 1861651614 - STEPHEN EDWARDS | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatrics Physician (208000000X) |
United | 76802 | $111.58 | 1326120734 - ANGELA EARHART | 452820649 - (TX) ANGELA EARHART PA | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76802 | $85.47 | 1063452555 - SHARADA GOWDA | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Neonatal-Perinatal Medicine Physician (2080N0001X) |
United | 76802 | $260.44 | 1639513971 - KELLY BORA | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Pediatric Critical Care Medicine Physician (2080P0203X) |
United | 76802 | $186.02 | 1790985984 - KATHARINE JOHNSON | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Neonatal-Perinatal Medicine Physician (2080N0001X) |
United | 76802 | $85.47 | 1467904797 - WILLIAM TANNER | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Surgical Physician Assistant (363AS0400X) |
United | 76802 | $85.47 | 1720335045 - CLAUDIA SOLER ALFONSO | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Clinical Genetics (M.D.) Physician (207SG0201X) |
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 76802 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76802 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 76802 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) |
| 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) |
| 76811-CPT | Moderate | Ultrasound, Pregnant Uterus, Real Time With Image Documentation, Fetal And Maternal Evaluation Plus Detailed Fetal Anatomic Examination, Transabdominal Approach; Single Or First Gestation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76802. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76802 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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