CPT 76816 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 76816 by major payers:
$130.20
$130.11
$140.78
$163.45
| 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 76816 | ||||||
United | 76816 | $192.38 | 1376580852 - SPARTANBURG MEDICAL CENTER, MEDICAL GROUP OF THE CAROLINAS - PIEDMONT WOMEN'S HEALTHCARE | 832531807 | SC | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $247.94 | 1356617435 - LISETTE TANNER | 581537752 - EMORY UNIVERSITY | GA | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76816 | $212.47 | 1760424733 - THOMAS VRADELIS | 320418835 - UWH OF THE CAROLINAS, PLLC | NC | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $299.39 | 1730263948 - JODANNE HEDRICK | 470765154 - ALEGENT CREIGHTON CLINIC | NE | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $203.63 | 1528069861 - RICHARD LATTA | 223693606 - REGIONAL WOMEN'S HEALTH GROUP, LLC | PA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $302.14 | 1356617435 - LISETTE TANNER | 581537752 - EMORY UNIVERSITY | GA | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76816 | $66.02 | 1487747440 - AFSHAN ASHFAQ | 113465690 | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $236.10 | 1730124173 - ANITA HUDSON-FRALEY | 271081647 - TRIANGLE PHYSICIAN NETWORK LLC | NC | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $246.55 | 1477680486 - MARY SUSAN SCHILLING | 43466314 - MASS GENERAL BRIGHAM INCORPORATED | MA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $34.18 | 1427016526 - SUCHARITHA VIGNESHWAR | 200000795 | VA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $37.25 | 1134788003 - STEPHANIE BOUSQUET | 160743134 - ROCHESTER GENERAL HOSPITAL | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $55.81 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 76816 | $196.89 | 1407203599 - AMANDA DESON | 464256391 | CA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $169.69 | 1225127731 - PATRICIA BAILEY-SARNELLI | 42888373 - BAYSTATE MEDICAL PRACTICES INC | MA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76816 | $92.70 | 1871740324 - ROBIN DILLARD | 561118388 | NC | 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 76816 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76816 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 76816 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 |
| 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) |
| 76817-CPT | Low | Ultrasound, Pregnant Uterus, Real Time With Image Documentation, Transvaginal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76816. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76816 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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