CPT Code 76801: First Trimester Obstetric Ultrasound Billing Guide

What Is CPT Code 76801?

CPT code 76801 reports a complete first-trimester obstetric ultrasound performed transabdominally before 14 weeks 0 days. It covers a single fetus or the first fetus in a multiple gestation and requires the provider to evaluate both fetal and maternal structures across five documented elements. When any required element is missing from the report without a clinical explanation, the exam does not qualify as complete and should be reported as the limited study, 76815.

What is the difference between 76801 and 76815? 76801 is the complete exam requiring five documented elements. 76815 is the limited quick look. If a required element is absent without explanation, the correct code is 76815, not 76801.

Does CPT 76801 need a modifier? For a global service in your own office, often no modifier is needed. Modifier 26 applies when the physician reads the study but the facility owns the equipment. Modifier TC applies when billing only the technical component.

How does 76801 reimbursement work in 2026? Payment depends on whether you bill globally or split into professional and technical components, the practice setting, and the payer. CMS applied a 2.5% efficiency adjustment to work RVUs for diagnostic imaging in CY 2026, and there are now two separate conversion factors.

The first ultrasound of a pregnancy is a routine moment in an obstetric practice, and CPT 76801 is the code that reports the complete version of that study. The operative word is complete. 76801 is not the quick look that confirms a heartbeat, and it is not the anatomy scan performed at twenty weeks. It is a defined first-trimester study with a specific set of elements that the report must document. Leave one of those elements out without explaining why, and the claim drops to a lower-paying limited code.

Across the billing companies in our network, documentation gaps on 76801 are one of the most common reasons OB practices lose revenue on imaging claims. Providers often come to us after noticing a pattern of downcoded ultrasounds, and the fix almost always traces back to the report, not the scan itself. This guide covers what CPT 76801 requires, the five elements that separate complete from limited, how the code relates to the other obstetric ultrasound codes, the modifiers that apply, what drives reimbursement in 2026, and the documentation practices that keep these claims clean. For a broader look at how OB/GYN billing codes are changing in 2027, including the maternity code restructure, see our code changes overview.

The Five Required Elements: Complete vs Limited

This is where the money is won or lost on a 76801 claim. To report the complete first-trimester exam, the ultrasound report must address five elements:

1. The number of gestational sacs and fetuses.

2. Gestational sac and fetal measurements appropriate for the gestational age (crown-rump length, gestational sac diameter).

3. A survey of the visible fetal and placental anatomic structures.

4. A qualitative assessment of amniotic fluid volume or gestational sac shape.

5. An examination of the maternal uterus and adnexa.

Two practical rules keep this realistic. First, the elements documented are those appropriate for the gestation and visible at the time of the scan. At seven or eight weeks, for example, an amniotic fluid assessment is not yet clinically meaningful, and a clear statement to that effect in the report is sufficient. Second, if an element cannot be visualized, the report must say so and explain why. What you cannot do is simply omit an element with no comment. When a required element is missing without explanation, the correct code is the limited study, 76815, not 76801.

One question we hear constantly from practice managers is whether their sonographers need to change how they scan. The answer is almost always no. The scan itself usually captures the required data. The gap is in the report: the physician or sonographer documents what they see but does not address what they could not see. Coders who notice a missing element should query the physician before assigning 76801. If the response confirms the element was not assessed and no clinical explanation exists, the correct code is 76815. For related guidance on transvaginal ultrasound coding with CPT 76830, see our dedicated guide.

76801 and Its Companion Codes

Obstetric ultrasound is a family of codes sorted by gestational age, scope, and approach. Knowing the neighbors keeps 76801 on the right claims and prevents accidental crossover into codes that belong at different stages of pregnancy.

CPT	What It Reports
76801	Complete obstetric ultrasound, first trimester (under 14 weeks 0 days), transabdominal, single or first gestation
+76802	Each additional gestation in the first trimester (add-on, reported with 76801)
76805	Complete obstetric ultrasound after the first trimester (14 weeks 0 days or later), single or first gestation
+76810	Each additional gestation after the first trimester (add-on, reported with 76805)
76811	Detailed (Level II) fetal anatomic exam, single gestation, for high-risk or specific indications
+76812	Each additional gestation for the detailed exam
76813	Nuchal translucency measurement, first trimester (often billed with 76801 when indicated)
+76814	Nuchal translucency, each additional gestation
76815	Limited obstetric ultrasound (the quick look), once per encounter
76816	Follow-up obstetric ultrasound, re-evaluating a known finding or growth
76817	Transvaginal obstetric ultrasound

It also helps to know what is not 76801:

• A limited quick look (heartbeat, position, or fluid only) is 76815, not 76801.
• A complete exam at 14 weeks 0 days or later is 76805, not 76801.
• A re-evaluation of a previously identified finding is 76816, not 76801.
• A transvaginal-only obstetric study is 76817. When a transvaginal scan is done only to complete the transabdominal exam, report 76801 alone.

In our experience matching providers with billing partners, confusion between 76801 and 76805 is more common than most practices realize. The gestational age cutoff at 14 weeks 0 days is absolute. A scan performed on the day the pregnancy reaches 14 weeks belongs under 76805, regardless of whether the provider considers the patient still in the first trimester.

Does CPT 76801 Need a Modifier?

For a routine global service performed and interpreted in your own office, often no modifier is needed. But 76801 is an imaging code, and imaging codes have a professional and technical split that drives most of the modifier questions providers encounter.

Modifier 26 (Professional Component): The physician’s interpretation and written report. Use it when the practice did not own the equipment. For example, a scan performed in a facility where the physician reads the study but the facility bills the technical side.

Modifier TC (Technical Component): The equipment, supplies, and technologist time. The entity that owns the machine and the staff bills this side. When your practice owns the equipment and interprets the study, bill globally with no 26 or TC.

The 76802 Add-On for Multiples: Report 76802 with 76801 for each additional fetus beyond the first. For twins, bill 76801 for the first fetus and 76802 for the second. Never report 76802 on its own.

Modifier 76 (Repeat Procedure): Use when the same provider repeats the ultrasound on the same day for a valid clinical reason (for example, a patient returns after acute abdominal pain following the initial scan).

Modifier 59 or the X Subset: Apply only when a transabdominal (76801) and a transvaginal (76817) study are both performed for distinct, separately documented medical necessity. If the transvaginal view simply completes the transabdominal exam, bill 76801 alone.

Modifier 25 on a Same-Day E/M: An evaluation and management visit can be billed with the ultrasound only when the E/M is a significant, separately identifiable service that goes beyond explaining the scan results, such as counseling on an abnormal finding.

The most common issue we see providers run into with modifiers is the 26/TC split in facility-based practices. A physician employed by a hospital who reads a study performed on hospital-owned equipment should bill modifier 26 only. The hospital bills TC. When the practice owns its own ultrasound equipment and the physician interprets in-house, the global code with no modifier is correct. Mismatching the modifier to the ownership arrangement is one of the fastest paths to a denial.

How Much Does CPT 76801 Reimburse in 2026?

There is no single fixed dollar amount for CPT 76801 reimbursement. Payment is driven by several factors that shift annually and vary by payer, and the 2026 Medicare Physician Fee Schedule introduced changes that directly affect diagnostic imaging codes like 76801.

The key factors that determine payment:

Professional vs. Technical Component: The professional component (interpretation and report) and the technical component (machine, supplies, technologist) are valued separately. A practice that owns its equipment and interprets the study earns both. A physician reading a facility’s study earns only the professional component.

Office vs. Facility Setting: The technical component is built almost entirely from practice expense RVUs. Where the scan is performed has a significant effect on what is collected, because practice expense values differ between office and facility settings.

Geographic Locality: Medicare adjusts payment using Geographic Practice Cost Indices (GPCIs) that reflect regional cost differences in physician work, practice expense, and malpractice.

2026 CMS Changes Affecting 76801

Three specifics from the CY 2026 Physician Fee Schedule final rule matter for this code:

1. CMS finalized a 2.5% efficiency adjustment that reduces work RVUs and intraservice times for most non-time-based codes, a category that includes diagnostic imaging like 76801.

2. CMS changed how it allocates indirect practice-expense RVUs by site of service, which can shift the technical component payment differently for office and facility settings.

3. There are now two 2026 conversion factors: a qualifying-APM factor and a non-qualifying factor. The exact allowable for 76801 depends on which conversion factor applies to the billing entity.

Many payers also enforce frequency limits, covering a set number of routine obstetric ultrasounds per pregnancy and treating 76801 as the once-per-pregnancy complete first-trimester study. Later first-trimester scans are typically reported as 76815 or 76816. Because the dollar amount shifts every January and varies by setting, component, locality, and payer, do not hard-code a reimbursement figure. Verify the current allowable in the Medicare Physician Fee Schedule for the relevant year and locality, and cross-reference each commercial payer’s contracted rate and ultrasound frequency policy. For practices looking to understand how these changes fit into the larger OB/GYN billing code landscape for 2027, we have a full overview.

Common 76801 Denials and How to Prevent Them

Across the billing companies we vet, these are the denial patterns that come up most frequently on 76801 claims. Each one traces back to a specific documentation or coding gap.

Missing Required Elements: The report does not address one of the five elements and gives no clinical reason. Fix: document each element or explain nonvisualization. Downcode to 76815 when the exam was genuinely limited.

Add-On Billed Alone or for a Singleton: 76802 is reported without 76801, or it appears on a claim for a single fetus. Fix: report 76802 only with 76801, and only when there is more than one gestation.

Wrong Gestational Age: 76801 is used at 14 weeks 0 days or later. Fix: switch to 76805 once the pregnancy reaches the 14-week threshold.

Exceeding Frequency Limits: 76801 is billed more than once per pregnancy or beyond the plan’s ultrasound allowance. Fix: report later first-trimester scans as 76815 or 76816, and confirm the payer’s per-pregnancy limit before billing.

76801 with 76817 Without Justification: Both a transabdominal and a transvaginal code are billed when only one study was warranted. Fix: bill 76801 alone unless a distinct, documented transvaginal study was medically necessary with separate findings.

Professional or Technical Component Errors: The global code is billed in a facility setting, or modifiers 26 and TC are mismatched to the ownership arrangement. Fix: bill globally only when the practice owns the equipment and interprets the study. Otherwise split with 26 or TC.

Missing Medical Necessity: The diagnosis code does not support an obstetric ultrasound. Fix: link a supported pregnancy ICD-10 code such as supervision of normal pregnancy (Z34 family), high-risk pregnancy supervision (O09 family), antenatal screening (Z36 family), or a specific clinical indication like bleeding or suspected ectopic. Report an obstetric ultrasound code for any study that begins as pregnancy-related, even if the final finding differs.

For a deeper reference on how OB/GYN billing guidelines apply across code families, including antepartum care billing with CPT 59426 and IUD insertion coding with CPT 58300, see our individual code guides.

Frequently Asked Questions