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 |
| Medicare Fee Schedule | View Medicare rates for 76805 |
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 | $90.05 | 1326069675 - REGINA ADAIR | 351972384 - PARKVIEW HEALTH SYSTEM INC | IN | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $259.91 | 1649258948 - ANDREA SHIELDS | 521725543 | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76805 | $123.92 | 1306502703 - RACHEL LABELLA | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopedic Physical Therapist (2251X0800X) |
United | 76805 | $454.73 | 1457317299 - PAULA KOLBAS | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | MA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $121.98 | 1396009668 - NKECHI EZIRIM | 274174150 | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76805 | $142.55 | 1760774178 - TEUTA SHEMSHEDINI | 562392010 | CO | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $169.86 | 1811000177 - CHARLESTON RADIOLOGISTS PA | 570634747 - CHARLESTON RADIOLOGISTS, P.A. | SC | Single Specialty Group (193400000X) |
United | 76805 | $127.27 | 1568591543 - KRISTIN RUSSO-RIVERA | 561248712 | NC | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $254.58 | 1043322233 - MALINI NIJAGAL | 943281657 | CA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $114.04 | 1972683225 - NIKOLAOS ZACHARIAS | 202642273 - (TX) KATHERINE THOMPSON MD PLLC | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76805 | $127.27 | 1588127328 - JOSEPH EDWARDS | 562138052 | NC | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $157.16 | 1194010199 - ABIDA HASAN | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76805 | $226.47 | 1861575979 - YESIM GULECYUZ | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Obstetrics & Gynecology Physician (207V00000X) |
United | 76805 | $58.31 | 1033587365 - GABRIELLE PHAM-CHE | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopedic Physical Therapist (2251X0800X) |
United | 76805 | $97.80 | 1952713380 - CHRISTOPHER PETR | 752302928 | 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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