CPT 76815 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 76815 by major payers:
$98.78
$101.51
$110.75
$125.00
| 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 76815 | ||||||
United | 76815 | $293.54 | 1891057584 - KIMBERLY KEEFE SMITH | 43466314 - MASS GENERAL BRIGHAM INCORPORATED | MA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $50.95 | 1982137436 - MONICA LAI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $76.73 | 1124069018 - BHARTI MAVANI | 223693606 - REGIONAL WOMEN'S HEALTH GROUP, LLC | NJ | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $119.83 | 1093248676 - KRUPA HARISHANKAR | 800756169 | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $53.38 | 1104182948 - BRYTANIE MARSHALL | 236291113 - GEISINGER CLINIC | PA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $107.91 | 1205815222 - STEPHEN COARSEY | 465137699 | NC | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $34.22 | 1437146263 - SALLY GROGONO | 264562522 - SETON FAMILY OF DOCTORS | TX | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $70.91 | 1851471338 - SETUL PARDANANI | 271648289 - STAMFORD HEALTH MEDICAL GROUP INC | CT | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $44.97 | 1396928222 - CHARLENE COLLIER | 640580940 - G A CARMICHAEL FAMILY HEALTH CENTER INC | MS | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $42.58 | 1013470129 - COLLEEN DELANEY | 271648289 - STAMFORD HEALTH MEDICAL GROUP INC | CT | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $78.01 | 1417111477 - SHAREEF RIAD | 362482996 - ROCKFORD RADIOLOGY ASSOCIATES | VA | Diagnostic Radiology Physician (2085R0202X) |
United | 76815 | $53.22 | 1437376373 - JESSICA ZARET | 61450168 - TRINITY HEALTH OF NEW ENGLAND PROVIDER NETWORK ORGANIZATION INC | CT | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $119.63 | 1497013353 - KEVIN MCRAE | 475419443 | GA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76815 | $83.95 | 1235424284 - KAMBRIE KATO | 231742016 - (PA) BARDEN, THORWARTH, DAUGHTRIDGE, LTD | VA | Diagnostic Radiology Physician (2085R0202X) |
United | 76815 | $71.19 | 1427555952 - KAYLA BURKHARDT | 364774713 - LSU HEALTH SCIENCES CENTER - SHREVEPORT FACULTY GROUP PRACTICE | LA | 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 76815 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76815 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 76815 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 |
|---|---|---|
| 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 |
| 76813-CPT | Low | Ultrasound, Pregnant Uterus, Real Time With Image Documentation, First Trimester Fetal Nuchal Translucency Measurement, Transabdominal Or Transvaginal Approach; Single Or First Gestation |
| 76815-CPT | Low | Ultrasound Pregnant Uterus Real Time With Image Documentation Limited (Eg Fetal Heart Beat Placental Location Fetal Position And/Or Qualitativeamniotic Fluid Volume) One Or More Fetuses. (Desc Rev 1/1/03) |
| 76816-CPT | Low | Ultrasound Pregnant Uterus Real Time With Image Documentation; Follow-Up (Eg Re-Evaluation Of Fetal Size By Measuring Standard Growth Parameters And Amniotic Fluid Volume Re-Evaluation Of Organ System(S) Suspected Or Confirmed To Be Abnormal On A Previous Scan) Transabdominal Approach Per Fetus (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 76815. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76815 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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