76813 Ultrasound

CPT 76813

CPT 76813: Nuchal Translucency UltrasoundNuchal Translucency Ultrasound

The short answer

Use 76813 for the nuchal translucency measurement ultrasound performed in the first trimester screening window, roughly 11 weeks 0 days to 13 weeks 6 days. It is a distinct screening study, not part of the complete first trimester scan 76801, and most payers require the measuring sonographer and interpreting physician to hold NT certification through NTQR or the Fetal Medicine Foundation. For each additional fetus add 76814.

Source: NCCISource: CMS MPFS 2026Source: AIUM

When to use 76813

Report 76813 when an NT measurement is obtained for aneuploidy risk assessment, usually alongside serum analytes in first trimester combined screening. The gestational window is narrow and the technique is standardized, which is why the certification requirement exists: payers and labs will not accept a measurement from an uncredentialed operator. Practices pursuing NT work should also expect accreditation scrutiny; some payers extend their AIUM-accreditation policies from the 76811 family to 76813. A complete first trimester scan done at the same sitting is separately reportable as 76801 when both studies are fully documented.

When to use 76813 vs 76801

76813 · NT screening

Aneuploidy screening is the purpose
11w0d to 13w6d window
Standardized NT measurement technique
Requires NTQR or FMF certification

76801 · Complete first trimester

Full survey: dating, viability, anatomy
Any point under 14 weeks
Crown-rump length drives dating
No NT certification required

Documentation checklist

NT claims are audited on technique and credentialing as much as on medical necessity. The report should make both easy to verify.

✓ Gestational age within the screening window, established by crown-rump length

✓ NT measurement recorded to a tenth of a millimeter

✓ Midsagittal image demonstrating proper technique stored

✓ Certified sonographer identified, with NTQR or FMF credential current

✓ Interpreting physician credentialed for NT interpretation

✓ Fetal number stated; per-fetus measurements for multiples

✓ Screening context noted, such as pairing with serum analytes

✓ Signed interpretation with the measurement and risk context

Global package rules

76813 is billed outside the global obstetric package and separately from 59400. It is normally paid once per pregnancy per fetus within the screening window. When both an NT study and a complete first trimester scan are performed and separately documented at one visit, report 76813 and 76801 together; some payers want a distinct-service modifier on the second study. NCCI

TC-26 components

Split the components when the reading physician does not own the equipment: modifier 26 for the interpretation, TC for the facility side. Because the certification attaches to people, an NT overread arrangement requires the interpreting physician, not just the scanning site, to hold the credential.

76813

Global: one entity owns equipment and interpretation

76813-26

Professional: interpretation only

76813-TC

Technical: equipment and technologist

Reimbursement

2026 · national Medicare averages

Component	Work RVU	Total RVU	2026 rate
76813Global	1.15	3.46	$115.57
76813-26Professional	1.15	1.69	$56.45
76813-TCTechnical	0.00	1.77	$59.12

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

N290 Provider not NT-certified with the payer

Why it happens

The payer could not match the rendering provider to an NTQR or FMF credential, or the certification had lapsed.

How to fix

Verify the sonographer's and physician's certifications are current and registered with the payer where required, then resubmit under the credentialed rendering NPI.

Source: AIUM

CO-50 Outside the screening window

Why it happens

The gestational age on the claim fell outside roughly 11w0d to 13w6d, where the NT measurement is not valid for screening.

How to fix

Confirm the CRL-based dating in the report. If the study was within window, correct the claim dates and diagnosis; if not, the measurement does not support 76813.

Source: ACOG/SMFM

CO-97 Bundled into a same-day first trimester scan

Why it happens

The payer collapsed 76813 into 76801 billed the same day.

How to fix

These are distinct studies with separate element sets. Append the payer's preferred distinct-service modifier and appeal with both reports.

Source: NCCI

CO-151 Repeat NT billed in the same pregnancy

Why it happens

A second NT study for the same fetus hit a once-per-pregnancy frequency edit.

How to fix

Repeats are rarely payable. If the first attempt failed for technical reasons and the repeat is documented as the completed study, appeal with both reports.

Source: CMS

CO-16 Missing or invalid TC-26 modifier

Why it happens

Component billing was expected but the modifiers were missing or both parties billed globally.

How to fix

Bill 76813-26 for the interpretation and 76813-TC for the technical side, one entity each.

Source: CMS

FAQ

What is the CPT code description for 76813?

In plain language, 76813 covers the first trimester nuchal translucency ultrasound: a standardized measurement of the fluid at the back of the fetal neck, taken between about 11 and 14 weeks as part of aneuploidy screening. It is billed for the first or only fetus, with 76814 for each additional fetus.

Who can perform and bill 76813?

A sonographer and interpreting physician who hold NT certification, in the United States usually through the Nuchal Translucency Quality Review program (NTQR) or the Fetal Medicine Foundation (FMF). Most payers and screening labs will not accept measurements from uncertified operators.

Can I bill 76813 and 76801 on the same day?

Yes, when both a complete first trimester scan and the NT screening study are performed and separately documented. Some payers require a distinct-service modifier on the second code.

What is the gestational window for 76813?

Approximately 11 weeks 0 days through 13 weeks 6 days, tied to a crown-rump length range. Outside that window the NT measurement loses screening validity and claims tend to deny.

How is 76813 billed for twins?

76813 for the first fetus and add-on 76814 for each additional fetus, with a separate NT measurement documented per fetus.

Has cell-free DNA screening replaced the NT scan?

Not for billing purposes. Many patients who screen with cfDNA still receive an NT study for structural assessment, and 76813 remains payable when documented and medically indicated. Payer screening policies vary, so verify coverage when both are ordered.

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.