CPT 76805 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 • TC - Technical component |
| Complexity Level | Low |
National average reimbursement for CPT 76805 by major payers:
$161.60
$166.15
$179.54
$206.36
| 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 76805 | ||||||
United | 76805 | $63.52 | 1750311387 - NKENGE JACKSON | 271095543 - COMPASSIONATE CARE FOR WOMEN | GA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $259.91 | 1649258948 - ANDREA SHIELDS | 521725543 | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76805 | $284.50 | 1386938918 - APARNA RAMANATHAN | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | WA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $96.55 | 1548290141 - BROOK THOMSON | 260553931 - SAINT ALPHONSUS SPECIALTY SERVICES INC | ID | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $222.82 | 1689985160 - LISA MACK | 60646668 - HARTFORD HOSPITAL | CT | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $139.94 | 1902895923 - MICHAEL KAROLY | 223693606 - REGIONAL WOMEN'S HEALTH GROUP, LLC | NJ | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $87.84 | 1093151854 - MARY BELNIAK | 61483728 - PHYSICIANS FOR WOMEN'S HEALTH, LLC | CT | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $127.27 | 1568591543 - KRISTIN RUSSO-RIVERA | 561248712 | NC | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $142.55 | 1760774178 - TEUTA SHEMSHEDINI | 562392010 | CO | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $66.84 | 1407911092 - RONALD CLARKE | 631202594 | AL | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $194.53 | 1780644807 - ELISA FELSEN-SINGER | 135562308 - NEW YORK UNIVERSITY | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $341.80 | 1023469715 - RACHEL MAROHL | 261175213 - INNOVIS HEALTH LLC | ND | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $92.19 | 1467573857 - CHRISTY PETTES | 830249710 | AL | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $157.16 | 1154549954 - MARIA VELAZQUEZ | 850434150 | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76805 | $183.03 | 1568457992 - MARION REYNOLDS | 271081647 - TRIANGLE PHYSICIAN NETWORK LLC | TX | 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 76805 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76805 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 76805 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 |
| 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) |
| 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 76805. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76805 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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