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See a sample rate comparisonCPT 76856 Fee Schedule
Medicare rates as of October 2026
CPT 76856 is classified under Radiology Procedures, in the Diagnostic Ultrasound Procedures subgroup.
Ultrasou Pelvic (Nonobstetric) Real Time W/ Image Documnt;, Ultrasound Pelvic (Nonobstetric) Real Time With Image Documentation;
| Key Fact | Detail |
|---|---|
| Service Type | Radiology Procedures Diagnostic Ultrasound Procedures |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 26 - Professional component 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $105.21 national non-facility rate (2026) · View Medicare rates for 76856 |
| Medicaid Fee Schedule | $85.00 median of the 8 states in the free preview · View Medicaid rates for 76856 |
National average reimbursement for CPT 76856 by major payers:
$129.90
BCBS / Anthem
$130.59
UnitedHealthcare
$142.18
Aetna
$155.60
Cigna
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CPT 76856
5 of 25 sample ratesHigher to lower in this preview
John Sowinski
$723.60Published rateJennifer Laroy
University Of Minnesota Health Clinics And Surgery Center Inc
$221.11Published rateKatherine Troy
$91.62Published rateCharlie Cheng
Sisters Of Charity Hospital Of Buffalo New York
$32.85Published rateProspere Remy
Bronxcare Health System
$17.76Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 76856 vs. Other Diagnostic Ultrasound Procedures Codes
The table lists codes related to 76856. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 76830-CPT | Low | Vaginal Ultrasound, Ultrasound (Sound Wave Images) Of The Reproductive System Taken By Inserting A Hand-Held Probe Into The Vagina. |
| 76831-CPT | Low | Uterus Ultrasound Enhanced, Ultrasound (Sound Wave Images) Taken Of The Uterus. Saltwater (Saline) Is Given To Highlight Parts Of The Video. |
| 76856-CPT | Low | Ultrasou Pelvic (Nonobstetric) Real Time W/ Image Documnt;, Ultrasound Pelvic (Nonobstetric) Real Time With Image Documentation; |
| 76857-CPT | Low | Echography Pelvic (Nonobstetr, Echography Pelvic (Nonobstetric) B-Scan Andor Real Timewith 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 76856. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76856 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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Frequently Asked Questions
CPT (Current Procedural Terminology) codes are a standardized set of five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are essential for billing and reimbursement processes, ensuring consistent communication of services rendered to insurance companies and patients. These codes help in tracking medical trends, outcomes, and managing healthcare costs.
If you are a patient, you can typically find the CPT code for a specific medical procedure on your medical bill, Explanation of Benefits (EOB) from your insurance company, or by asking your healthcare provider's billing department directly. For healthcare professionals, CPT codebooks and online coding tools are available from the American Medical Association (AMA) and other medical coding resources.
Yes, CPT codes are a key component in estimating the cost of a medical procedure. Providers and insurance companies use these codes to determine pricing and reimbursement rates. To get an estimate for a specific procedure based on its CPT code and your location, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool where users can search with a CPT code and specific location to find relevant pricing information. You can also contact your insurance provider or the healthcare facility directly for a personalized estimate.
CPT (Current Procedural Terminology) codes are a subset of HCPCS (Healthcare Common Procedure Coding System) codes. CPT codes (Level I HCPCS codes), maintained by the American Medical Association (AMA), specifically describe medical procedures and services performed by physicians and other healthcare professionals. HCPCS Level II codes, maintained by the Centers for Medicare & Medicaid Services (CMS), cover non-physician services, ambulance services, durable medical equipment (DME), prosthetics, orthotics, and supplies. In essence, all CPT codes are HCPCS codes, but not all HCPCS codes are CPT codes.
While the CPT codes themselves are standardized across the United States, the reimbursement rates and specific coverage policies associated with those codes can vary significantly between different insurance companies, healthcare plans, and geographic locations. Factors like negotiated rates, provider contracts, and regional cost-of-living differences all influence the final cost. For specific pricing in your area, using a tool like Payerprice's fee schedule lookup, which allows searches by CPT code and specific location, can provide more accurate local estimates.