CPT code 76801: Ultrasound, obstetric, 1st trimester, single or first gestation

What is the 76801 CPT code?

CPT 76801 refers to a complete ultrasound evaluation of a pregnant uterus during the first trimester, performed to assess early pregnancy development. More specifically, to:

• Confirm the viability
• Given the estimation of the gestational age and number of gestational sacs and fetuses
• Assessment or survey of the fetus's early anatomy

It includes a transabdominal and/or transvaginal scan of a single or first gestation.

This code is commonly used in routine prenatal care or when there are concerns, such as bleeding or unknown dates.

Documentation requirements

Complete documentation is crucial for accurate coding and reimbursement. The patient's medical record must support the ultrasound procedure performed and must have the following documented:

• Number of fetuses and chorionicity
• Gestational age and fetal viability
• Measurements: crown-rump length, yolk sac, heartbeat, mean gestational sac diameter, etc.
• Uterus, adnexa, and pelvic anatomy
• Date and indication for scan
• Image acquisition and interpretation

Billing guidelines

For accurate medical billing and reimbursement, when using the CPT code 76801, healthcare providers must keep in mind and follow the guidelines below:

• The procedure must be medically necessary, and the documents must support or prove the medical decision
• Report once per pregnancy for initial evaluation of a single or first gestation.
• Do not use with 76817 (transvaginal) if performed at the same encounter unless required and distinct.
• Include modifiers if necessary. For example, add Modifier 76 if the same provider performs the ultrasound procedure more than once on the same day.
• Not reported for follow-up scans—use 76815 or 76816.
• Coverage and specific billing rules have been verified with the relevant payers.