CPT 76831 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 • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 76831 by major payers:
$140.47
$138.32
$151.53
$174.09
| 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 76831 | ||||||
United | 76831 | $103.69 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 76831 | $117.00 | 1316989122 - KARIN WOLLSCHLAEGER | 880926474 - (CO) UPTOWN COMMUNITY HEALTH CENTER INC | CO | Obstetrics & Gynecology Physician (207V00000X) |
United | 76831 | $58.81 | 1659633725 - GARY MORRIS | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 76831 | $34.56 | 1609288372 - SONAM SINGH | 860830701 | AZ | Obstetrics & Gynecology Physician (207V00000X) |
United | 76831 | $121.26 | 1508829912 - ALGIMANTAS JECIUS | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Surgery Physician (208600000X) |
United | 76831 | $150.86 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 76831 | $54.11 | 1285698902 - FOUAD DARWISH | 815234100 | CA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76831 | $84.44 | 1679781231 - JENNIFER BURKE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | FL | Certified Registered Nurse Anesthetist (367500000X) |
United | 76831 | $110.05 | 1346225349 - INES SANCHO TORRES | 200096809 - PHYSICIANS OF UNIVERSITY HOSPITAL PC | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 76831 | $121.26 | 1750767729 - NAUMAN FAROOQ | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | TX | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
United | 76831 | $155.05 | 1578653028 - TONJA HARRIS-STANSIL | 680287629 | CA | Obstetrics & Gynecology Physician (207V00000X) |
United | 76831 | $139.78 | 1740324235 - DEBORAH MERRILL | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | WA | Anesthesiology Physician (207L00000X) |
United | 76831 | $356.17 | 1447598677 - MAKOTO TOKIWA | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 76831 | $260.04 | 1063447043 - JEFFREY PENIKAS | 931097258 | OR | Obstetrics & Gynecology Physician (207V00000X) |
United | 76831 | $60.79 | 1619930484 - SAMUEL OWUSU | 236291113 - GEISINGER CLINIC | PA | 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 76831 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76831 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 76831 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 |
|---|---|---|
| 76830 | Low | Ultrasound Scan Of Uterus, Ovaries, Tubes, Cervix And Pelvic Area Through Vagina |
| 76831 | Low | Saline Infusion Sonohysterography (Sis) Including Color Flow Doppler When Performed (Rvsd 1/1/04) |
| 76856 | Low | Ultrasound, Pelvic (Nonobstetric), Real Time With Image Documentation; Complete |
| 76857 | Low | Ultrasound Pelvic (Nonobstetric) B-Scan And/Or Real Time With Image Documentation; Limited Or Follow-Up (Eg For Follicles) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76831. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76831 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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