CPT 76828 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 • 59 - Distinct Procedural Service • 26 - Professional component |
| Complexity Level | Low |
National average reimbursement for CPT 76828 by major payers:
$62.41
$72.01
$66.55
$77.44
| 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 76828 | ||||||
United | 76828 | $65.87 | 1942510987 - CATHARINA SOLOMON | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Nurse Practitioner (363LP0200X) |
United | 76828 | $65.87 | 1790282143 - TIFFANY NAPPIER | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Nurse Practitioner (363LP0200X) |
United | 76828 | $219.16 | 1093898447 - JAY RODEN | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Pediatric Surgery Physician (2086S0120X) |
United | 76828 | $65.87 | 1982380333 - JULIA MOORHEAD | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Medical Physician Assistant (363AM0700X) |
United | 76828 | $65.87 | 1902096019 - ANJALI RANADE | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatrics Physician (208000000X) |
United | 76828 | $186.28 | 1760919229 - JENNIFER CARNEY | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Neonatal Nurse Practitioner (363LN0000X) |
United | 76828 | $65.87 | 1932628153 - PARTHA CHAKRABORTY | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Gastroenterology Physician (2080P0206X) |
United | 76828 | $65.87 | 1407086861 - MESHA MARTINEZ | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Radiology Physician (2085P0229X) |
United | 76828 | $55.70 | 1033292750 - MICHAEL BEBBINGTON | 742800601 - (TX) DELL CHILDRENS MEDICAL GROUP | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76828 | $87.52 | 1750575742 - PAULA SMITH | 742967081 - (TX) HILLCREST PHYSICIAN SERVICES | TX | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 76828 | $219.16 | 1700892148 - STEPHEN KIMMEL | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Pediatric Surgery Physician (2086S0120X) |
United | 76828 | $65.87 | 1366633760 - TINA SPENCER | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Women's Health Nurse Practitioner (363LW0102X) |
United | 76828 | $65.87 | 1699111666 - JULIAN SWANSON | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 76828 | $219.16 | 1174755466 - SHEHZAD HUDA | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Neonatal-Perinatal Medicine Physician (2080N0001X) |
United | 76828 | $65.87 | 1245685411 - AMY DUTKO | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Pediatric Critical Care Medicine Physician (2080P0203X) |
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 76828 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76828 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 76828 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 |
|---|---|---|
| 76820-CPT | Low | Doppler Velocimetry, Fetal; Umbilical Artery |
| 76821-CPT | Low | Doppler Velocimetry, Fetal; Middle Cerebral Artery |
| 76825-CPT | Moderate | Echocardiography, Fetal, Cardiovascular System, Real Time With Image Documentation (2d), With Or Without M-Mode Recording; |
| 76828-CPT | Low | Doppler Echocardiography Fetal Cardiovascular System Pulsed Wave And/Or Continuous Wave With Spectral Display; 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 76828. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76828 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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