76811 Ultrasound

CPT 76811

CPT 76811: Detailed Fetal Anatomy UltrasoundDetailed Fetal Anatomy Ultrasound

The short answer

Use 76811 for a detailed, high-risk fetal anatomic survey that goes beyond the standard scan. It is billed separately from the global obstetric package and typically reported once per pregnancy per fetus. When the study is only a standard anatomy scan, report 76805 instead.

Source: NCCISource: CMS MPFS 2026Source: ACOG/SMFM

When to use 76811

Report 76811 when a detailed anatomic evaluation is medically indicated, most often for a pregnancy flagged as high-risk or after an abnormal or suspicious finding on a standard scan. The study requires a fuller structural survey and more extensive documentation than the routine anatomy exam. Many payers restrict 76811 to maternal-fetal medicine specialists or AIUM-accredited facilities, so verify credentialing requirements per payer before billing.

When to use 76811 vs 76805

76811 · Detailed

High-risk pregnancy or prior anomaly
Abnormal or unclear standard scan
Referral for targeted evaluation
Higher RVUs, once per pregnancy

76805 · Standard

Routine second-trimester survey
Low-risk baseline anatomy scan
No high-risk indication on file
Lower RVUs, standard documentation

Documentation checklist

Payers expect the record to show why the detailed study was warranted and that a complete anatomic survey was performed and interpreted.

✓ Documented high-risk indication (prior anomaly, abnormal standard scan, or maternal condition)

✓ Detailed anatomic survey of all required fetal structures

✓ Fetal biometry and growth parameters recorded

✓ Images permanently stored and retrievable on request

✓ Signed interpretation with findings and impression

✓ Performed or supervised by a qualified MFM or trained sonologist

✓ Gestational age and singleton or multiple status noted

✓ Comparison to prior imaging where applicable

Global package rules

Obstetric ultrasounds are not bundled into the global obstetric package. 76811 is billed separately from 59400 and is not part of routine antepartum care. For twins, report 76811 for the first fetus and 76812 for each additional fetus, with anatomy documented per fetus. NCCI

TC-26 components

When the interpreting physician does not own the equipment, split the service. Bill the professional interpretation with modifier 26 and let the facility bill the technical component with modifier TC. Report the global code only when one entity provides both. Practices without AIUM accreditation or an MFM on staff often contract the professional component out as an overread.

76811

Global — one entity owns equipment and interpretation

76811-26

Professional — interpretation only

76811-TC

Technical — equipment and technologist

Reimbursement

2026 · national Medicare averages

Component	Work RVU	Total RVU	2026 rate
76811Global	1.85	5.45	$182.03
76811-26Professional	1.85	2.71	$90.52
76811-TCTechnical	0.00	2.74	$91.52

National amounts under the 2026 Medicare Physician Fee Schedule (non-facility total RVU x $33.4009 conversion factor, no locality/MAC adjustment). Commercial and Medicaid rates differ. Verify current values with your MAC before billing.

Common denials

CO-97 76811 bundled into another service

Why it happens

The payer treated 76811 as included in a same-day service or in the global obstetric package.

How to fix

Obstetric ultrasounds are outside the global package. Append an appropriate modifier or document the distinct high-risk indication, then appeal with the NCCI edit rationale.

Source: NCCI

CO-16 Missing or invalid TC-26 modifier

Why it happens

Professional and technical components were billed without 26 or TC when the facility owns the equipment.

How to fix

Split the claim: bill 76811-26 for the interpretation and let the facility bill 76811-TC for the technical component.

Source: CMS

CO-236 76811 and 76805 reported same day

Why it happens

Both a standard and a detailed anatomy scan were reported for the same encounter and anatomy.

How to fix

Report 76811 alone when a detailed survey is performed. Do not also bill 76805 for the same anatomy on the same date.

Source: NCCI

CO-50 Not medically necessary

Why it happens

No high-risk indication was on file to support the detailed study over the standard 76805.

How to fix

Link a supported ICD-10 indication and retain the referral or the abnormal prior scan that prompted the detailed exam.

Source: ACOG/SMFM

N290 Rendering provider not eligible

Why it happens

The interpreting provider was not credentialed with the payer for the professional component.

How to fix

Confirm enrollment and the correct rendering NPI for the interpreting physician before resubmitting.

Source: CMS

FAQ

What is the CPT code description for 76811?

In plain language, 76811 covers a detailed fetal anatomic ultrasound: a complete survey of fetal structures performed when a pregnancy is high-risk or a standard scan raised concerns. It includes everything in a standard scan plus a deeper structural evaluation.

Can 76811 be billed more than once in a pregnancy?

Usually once per pregnancy per fetus. A repeat detailed study needs a new, separately documented indication, otherwise expect a frequency denial.

How is 76811 different from 76805?

76805 is a standard second or third trimester anatomy scan. 76811 is a deeper, high-risk detailed anatomic evaluation and carries higher documentation requirements and RVUs.

Is 76811 inside the global OB package?

No. Obstetric ultrasounds are billed separately from the global package and are never bundled into 59400.

For twins, how do I report the detailed scan?

Report 76811 for the first fetus and 76812 for each additional fetus, with the anatomic survey documented separately per fetus.

Who can perform and interpret 76811?

A provider qualified in detailed fetal anatomic imaging, typically maternal-fetal medicine or a trained sonologist under appropriate physician supervision. Some payers additionally require AIUM accreditation or MFM involvement, check the payer's policy.

CPT® is a registered trademark of the American Medical Association. Educational reference only, not billing, legal, or medical advice. Maintained by Ouma Health, a maternal-fetal telemedicine practice. Printed from obcodingguide.com, content current as of July 2026.