What Is CPT Code 76805?
CPT code 76805 is the standard code for a complete obstetric ultrasound performed at 14 weeks 0 days of gestation or later, using a transabdominal approach for a single or first gestation. It covers a full fetal and maternal evaluation, including fetal biometry, a survey of fetal anatomy, placental location, amniotic fluid assessment, and a maternal adnexal evaluation, and it is the code most OB/GYN practices bill for the routine second trimester anatomy scan.
When it applies: 76805 takes over from 76801 at the 14-week gestational threshold. The date of the scan, not the date the order was placed, determines which code to use.
What it requires: The scan must document every required anatomic element, from the lateral cerebral ventricles through the four extremities, or the claim risks a denial for incomplete documentation.
For multiples: 76805 covers the first or only fetus. Each additional fetus in the same pregnancy requires the add-on code 76810, billed alongside 76805, not in place of it.
What CPT Code 76805 Covers
CPT 76805 reports a complete obstetric ultrasound evaluation performed after the first trimester. The AMA descriptor reads: “Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (greater than or equal to 14 weeks 0 days), transabdominal approach; single or first gestation.” The word “complete” is doing the heavy lifting in that definition, because it means every required anatomic element must be evaluated and documented, whether the element is normal, abnormal, or not visualized.
In practice, 76805 is what most OB/GYN practices bill for the standard anatomy scan performed between 18 and 22 weeks, though the code is valid for any complete transabdominal OB ultrasound from 14 weeks through delivery. It covers fetal number and presentation, cardiac activity, fetal biometry (biparietal diameter, head circumference, abdominal circumference, and femur length), a survey of intracranial, spinal, and abdominal anatomy, placental location and appearance, qualitative or semi-qualitative amniotic fluid assessment, and a maternal uterine and adnexal evaluation.
Most payers allow only one complete OB ultrasound per pregnancy, whether that is 76801 in the first trimester or 76805 after the first trimester. Any subsequent scan typically bills as 76816 (follow-up) or 76815 (limited), depending on the clinical indication and what was evaluated. One question we hear constantly from OB/GYN practice managers is why their ultrasound claims deny when the scan clearly happened. The answer almost always traces back to documentation: the scan was performed, but the report did not confirm that every required element was assessed.
Required Anatomy for CPT 76805
The Society for Maternal-Fetal Medicine (SMFM) and the American Institute of Ultrasound in Medicine (AIUM) both publish required element lists for 76805. Every element must be documented, whether visualized or not. If fetal position prevents visualization of a structure, the report must state that the element was attempted and not visualized. Silence on an element is treated as an incomplete exam.
The required elements for CPT 76805, organized by region, are as follows:
Head and neck: lateral cerebral ventricles, choroid plexus (right and left), midline falx, cavum septi pellucidi, cerebellum, cisterna magna.
Face: upper lip.
Chest: cardiac activity, four-chamber view, left ventricular outflow tract, right ventricular outflow tract.
Abdomen: stomach (presence, size, and situs), kidneys, urinary bladder, cord insertion site into fetal abdomen, umbilical cord vessel number.
Spine: cervical, thoracic, lumbar, sacral spine.
Extremities: legs, arms.
Placenta: location, relationship to internal os, appearance.
Maternal anatomy: uterus and adnexa.
Standard evaluation: fetal number, presentation, qualitative or semi-qualitative amniotic fluid estimate.
Biometry: BPD, head circumference, femur length, abdominal circumference, estimated fetal weight.
Across the billing companies we vet for OB/GYN practices, the single most common reason for a 76805 denial is a report that documents 90% of the anatomy but omits one or two elements without a “not visualized” notation. Payers treat that omission as an incomplete exam and either deny the claim outright or downcode it to 76815. The fix is a documentation checklist built into the ultrasound report template that forces a finding or a “not visualized” entry for every required structure.
CPT 76805 vs 76811: Standard Scan or Detailed Anatomy Survey
CPT 76811 is the detailed fetal anatomic examination, a higher-tier scan ordered only when a specific medical indication exists, such as a suspected fetal anomaly, an abnormal screening result, or a high-risk pregnancy condition. It requires every element documented for 76805 plus an expanded evaluation of intracranial anatomy (third ventricle, fourth ventricle, corpus callosum, integrity and shape of the cranial vault), facial structures (profile, coronal face including nose, lips, and lens), and additional organ-specific abdominal anatomy.
| Feature | 76805: Complete OB Scan | 76811: Detailed Fetal Anatomic Exam |
|---|---|---|
| Gestational window | 14 weeks 0 days or later | 14 weeks 0 days or later |
| Clinical indication | Routine screening anatomy scan | Suspected anomaly or high-risk indication required |
| Anatomy scope | Standard fetal and maternal evaluation | All 76805 elements plus expanded cranial, facial, and organ detail |
| Frequency | Most payers allow one per pregnancy | Once per pregnancy per provider, by indication only |
| Add-on for multiples | 76810 for each additional fetus | 76812 for each additional fetus |
| 2026 Medicare national rate | $135.94 (4.07 total RVUs) | Higher RVUs reflecting expanded work |
The escalation from 76805 to 76811 is not a provider choice based on thoroughness. It is a coding distinction based on medical necessity. If the anatomy scan was ordered as a routine screen and no anomaly indication is documented, 76805 is the correct code regardless of how many images the sonographer captured. Billing 76811 without a qualifying indication is one of the fastest paths to an audit, and providers often come to us after a payer flags a pattern of 76811 claims with no supporting diagnosis. If the scan starts as a 76805 and an unexpected finding triggers a more detailed evaluation in the same session, report 76811 alone, since it includes every 76805 element, and document the clinical decision to escalate.
How to Bill 76805 for Twin and Multiple Gestations
CPT 76805 covers the first or only fetus in the pregnancy. For each additional fetus evaluated in the same session, the add-on code 76810 is reported alongside 76805. A twin pregnancy ultrasound at 20 weeks is billed as 76805 plus 76810, not as two units of 76805.
This is one of the most common OB ultrasound billing errors we see across the practices matched through our platform. A twin scan billed as 76805 alone leaves half the ultrasound revenue on the table. The fix is a chart-review checkpoint: any pregnancy with an ICD-10 code from the O30 multiple gestation category must have an add-on code (76810 in the second and third trimesters, 76802 in the first trimester) on every applicable ultrasound claim. For higher-order multiples (triplets, quadruplets), report 76810 once for each additional fetus beyond the first.
If your practice also performs transvaginal imaging alongside the transabdominal scan in the same session, the transvaginal OB ultrasound code 76817 may be reported separately with modifier 59 or XU when it is medically indicated and documented as a distinct service. For the non-obstetric transvaginal ultrasound rules, see our guide to CPT code 76830.
CPT 76805 Reimbursement in 2026
Under the 2026 Medicare Physician Fee Schedule, CPT 76805 carries a total of 4.07 RVUs (0.97 work, 3.03 practice expense, 0.07 malpractice) and a national Medicare allowed amount of approximately $135.94 before geographic adjustments. The conversion factor for 2026 is $33.4009 for non-qualifying APM participants.
Because 76805 is a diagnostic imaging code, it is subject to professional and technical component splitting. If the practice owns the ultrasound equipment and the provider interprets the images, the practice bills the global code (76805 with no modifier). If the practice owns the equipment but an outside radiologist interprets, the practice bills the technical component (76805-TC) and the radiologist bills the professional component (76805-26). Getting the component split wrong is a denial that is easy to prevent and expensive to repeat.
Commercial payer rates for 76805 vary widely, with contracted rates typically ranging from $97 to $260 depending on the payer, the market, and the practice’s contract terms. Practices billing a high volume of OB ultrasounds should review their fee schedules annually to confirm they are not leaving money on the table, particularly as payer contracts come up for renewal. For a look at the broader OB/GYN billing code landscape heading into the new year, see the 2027 OB/GYN billing code changes overview.
If your OB ultrasound claims are denying for incomplete documentation or wrong component billing, the problem is upstream of the claim. A billing partner with real OB/GYN experience catches these errors before they cost you revenue. Get matched with vetted OB/GYN billing companies, free.
Common Denials and How to Prevent Them
OB ultrasound denials follow a predictable pattern. The practices that fix them treat each one as a process failure, not a one-off mistake.
Incomplete documentation. The scan report omits one or more required anatomic elements without a “not visualized” notation. The payer downcodes to 76815 or denies entirely. Fix: build a documentation checklist into the ultrasound report template that forces a finding or an explicit “not visualized” entry for every required structure.
Wrong gestational threshold. 76805 is billed for a scan performed before 14 weeks 0 days, when the correct code is 76801. Fix: confirm gestational age from the chart before selecting the CPT code. The date of the scan determines the code, not the date of the order.
Missing add-on for multiples. A twin pregnancy scan is billed as 76805 alone, leaving 76810 off the claim. Fix: flag every chart with an O30 ICD-10 code for an add-on checkpoint before claim submission.
Second complete scan denied as duplicate. Most payers allow only one complete OB ultrasound per pregnancy. A second complete scan should be billed as 76816 (follow-up) unless a new, documented clinical indication supports a second complete exam. Fix: verify payer policy on repeat complete scans and append the appropriate modifier and supporting diagnosis.
Component split error. The practice bills the global code when an outside radiologist performed the interpretation. Fix: confirm whether the interpreting provider is internal or external before submitting the claim, and apply modifier 26 or TC accordingly.
Professional vs Technical Component Billing
CPT 76805 has both a professional component (the physician interpretation and report) and a technical component (the equipment, the sonographer, and the image acquisition). How the practice bills depends on who owns each piece.
| Scenario | Practice Bills | Radiologist Bills |
|---|---|---|
| Practice owns equipment and interprets | 76805 (global, no modifier) | N/A |
| Practice owns equipment, outside radiologist interprets | 76805-TC | 76805-26 |
| Hospital owns equipment, practice interprets | 76805-26 | N/A (hospital bills TC) |
In our experience matching OB/GYN providers with billing partners, the component split is one of the billing details that most often gets set once and never revisited. Practices that add or drop an outside radiology read, switch ultrasound equipment ownership, or move scanning to a hospital outpatient department need to update their claim configuration at the same time. A mismatched component modifier creates a denial that repeats on every ultrasound claim until someone catches it.
Frequently Asked Questions
What is CPT code 76805?
CPT code 76805 is the standard code for a complete obstetric ultrasound performed at 14 weeks 0 days of gestation or later using a transabdominal approach. It covers a full fetal and maternal evaluation including fetal biometry, anatomic survey, placental location, amniotic fluid assessment, and maternal adnexal evaluation.
What is the difference between CPT 76805 and 76811?
CPT 76805 is the standard complete OB ultrasound for routine screening. CPT 76811 is a detailed fetal anatomic examination ordered only when a specific medical indication exists, such as a suspected anomaly or a high-risk pregnancy condition. 76811 requires all 76805 elements plus expanded cranial, facial, and organ-specific evaluation.
How do you bill 76805 for twins?
Bill 76805 for the first fetus and add-on code 76810 for each additional fetus evaluated in the same session. A twin pregnancy ultrasound at 20 weeks is 76805 plus one unit of 76810. Do not bill two units of 76805.
Can 76805 and 76801 be billed together on the same date?
In most cases, no. Both codes represent a complete OB ultrasound, and payers generally allow only one complete scan per pregnancy. If the gestational age is 14 weeks 0 days or later, 76805 is the correct code. Billing both on the same date typically triggers a denial unless the documentation supports two medically distinct evaluations.
What documentation is needed for CPT 76805?
The report must document every required anatomic element defined by the SMFM and AIUM, including head and neck structures, cardiac views with outflow tracts, abdominal organs, all four spine segments, extremities, placental location, amniotic fluid volume, fetal biometry, and maternal anatomy. Any element not visualized must be documented as attempted and not visualized.
How much does Medicare pay for CPT 76805 in 2026?
The 2026 Medicare national allowed amount for CPT 76805 is approximately $135.94 before geographic adjustments, based on 4.07 total RVUs and the $33.4009 conversion factor. Actual payment varies by locality after GPCI adjustments and by whether the practice bills the global, professional, or technical component.
What is the difference between 76805 and 76815?
CPT 76805 is a complete OB ultrasound covering the full fetal and maternal evaluation. CPT 76815 is a limited OB ultrasound that evaluates only one or two specific elements, such as fetal heart rate, position, or fluid level. 76815 is used for quick targeted checks, not as a substitute for an incomplete 76805 scan.
Does CPT 76805 have a global period?
No. CPT 76805 does not carry a global surgical period. It is a diagnostic imaging code, so there is no postoperative follow-up window bundled into the payment. Each medically indicated scan is billed independently.
Next Steps
For the non-obstetric transvaginal ultrasound rules that commonly pair with OB imaging visits, see our breakdown of CPT code 76830.
For a full look at the OB/GYN billing changes taking effect in the new year, read the 2027 OB/GYN billing code changes overview.
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OB ultrasound billing errors are quiet revenue leaks: incomplete documentation, missing add-on codes for twins, and component splits that were set once and never updated. A billing partner with real OB/GYN experience catches these before they cost you. OB/GYN Bill Co matches your practice with vetted billing companies that specialize in obstetrics and gynecology, free. Over 2,000 providers matched nationwide, rates starting at 2.95%.
