CPT 76826 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 76826 by major payers:
$185.04
$168.76
$186.41
$219.12
| 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 76826 | ||||||
United | 76826 | $112.13 | 1760417869 - AUDREY TAMM | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatrics Physician (208000000X) |
United | 76826 | $195.50 | 1881673655 - KERRY SEMBERA | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Nurse Practitioner (363LP0200X) |
United | 76826 | $195.50 | 1710319850 - VANESSA KASTNER | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Nurse Practitioner (363L00000X) |
United | 76826 | $195.50 | 1437352614 - AMARYLLIS ARRAUT | 650816256 - (TX) OBSTETRIX MEDICAL GROUP OF TEXAS BILLING INC | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76826 | $112.13 | 1841795002 - HEMALI PATEL | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Neurology Physician (2084N0400X) |
United | 76826 | $195.50 | 1598115313 - MARIA HAPPE | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Critical Care Pediatric Nurse Practitioner (363LP0222X) |
United | 76826 | $112.13 | 1043796667 - MARWA MANSOUR | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Critical Care Medicine Physician (2080P0203X) |
United | 76826 | $195.50 | 1427574938 - TIMESHA EDWARDS | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Physician Assistant (363A00000X) |
United | 76826 | $195.50 | 1619100773 - NIDHI BANSAL | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Endocrinology Physician (2080P0205X) |
United | 76826 | $132.22 | 1437374626 - HEALTHCARE SPECIALISTS, PLLC | 760510808 - (TX) HEALTHCARE SPECIALISTS PLLC | TX | Neonatal-Perinatal Medicine Physician (2080N0001X) |
United | 76826 | $112.13 | 1760713531 - HEATHER THOMPSON | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Nurse Practitioner (363L00000X) |
United | 76826 | $195.50 | 1679653091 - SUSAN RAINE | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Obstetrics & Gynecology Physician (207V00000X) |
United | 76826 | $195.50 | 1063460277 - AVOLONNE KIMBLE | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Pediatrics Physician (208000000X) |
United | 76826 | $112.13 | 1508095209 - ROHINI COORG | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Epilepsy Physician (2084E0001X) |
United | 76826 | $195.50 | 1558577676 - JEANNINE SCHUMAN MCCOY | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Pediatric Cardiology Physician (2080P0202X) |
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 76826 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76826 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 76826 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 |
|---|---|---|
| 76818-CPT | Low | Fetal Biophysical Profile |
| 76819-CPT | Low | Fetal Biophysical Profile; Without Stress Or Non-Stress Testing |
| 76825-CPT | Moderate | Echocardiography, Fetal, Cardiovascular System, Real Time With Image Documentation (2d), With Or Without M-Mode Recording; |
| 76826-CPT | Low | Echocardiography, Fetal, Cardiovascular System, Real Time With Image Documentation (2d), With Or Without M-Mode Recording; Follow-Up Or Repeat Study |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76826. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76826 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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