CPT code 76801 is for an ultrasound exam of a single fetus under 14 weeks, used to assess early pregnancy development and health.
CPT code 76801 is used for billing an ultrasound procedure that is performed on a pregnant woman who is less than 14 weeks along in her pregnancy. This code specifically applies when the ultrasound is conducted to examine a single fetus. The purpose of this ultrasound is typically to confirm the pregnancy, estimate the gestational age, and assess the overall health and development of the fetus at this early stage.
1. Modifier 26 - Professional Component: Similar to 76800, this modifier is used when only the professional component of the service is being billed, indicating billing for the interpretation of the ultrasound.
2. Modifier TC - Technical Component: Used when only the technical component is being billed, indicating billing for the equipment and technician's time.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the ultrasound is performed as a distinct service from other procedures on the same day, indicating it was separate and necessary.
4. Modifier 76 - Repeat Procedure by Same Physician: Used if the same provider performs the ultrasound more than once on the same day for the same patient, indicating the procedure was repeated.
5. Modifier 77 - Repeat Procedure by Another Physician: Used if a different provider performs the ultrasound more than once on the same day for the same patient, indicating the procedure was repeated by another physician.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. Proper use of modifiers can prevent claim denials and ensure compliance with payer requirements.
The CPT code 76801 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The reimbursement rates and coverage specifics for CPT code 76801 can vary based on geographic location and other factors, which are determined by the respective Medicare Administrative Contractor (MAC) for each region.
Healthcare providers should consult their local MAC for detailed information on reimbursement rates and any specific billing requirements related to CPT code 76801.
Discover the power of precision with MD Clarity's RevFind software. Our advanced solution meticulously analyzes your contracts to detect underpayments, pinpointing discrepancies down to the CPT code level, including CPT 76801, and by individual payer. Ensure you're receiving the full reimbursement you deserve. Schedule a demo today to see how RevFind can enhance your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
