Reviewed by certified coders + a maternal-fetal medicine physician / Updated for 2026
OB Coding Guide
OB Coding Guide
obcodingguide.com/codes/76819/
Clinical review: Sina Haeri, MD, MHSA (MFM) · Coder review pending · Drafted July 2026
76819 Antepartum testing
CPT 76819

CPT 76819: Biophysical Profile without Non-Stress TestBiophysical Profile without Non-Stress Test

The short answer

Use 76819 for a biophysical profile scored on the four ultrasound components, fetal breathing, movement, tone, and amniotic fluid, without a non-stress test in the composite. When an NST is performed as a separately documented service at the same visit, it can be billed with 59025 alongside 76819, which is the main practical difference from 76818.

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

When to use 76819

Report 76819 when surveillance uses the ultrasound-only BPP. That happens two ways in practice: the protocol genuinely omits the tracing, or the practice runs the NST and the ultrasound as separate services and reports 76819 plus 59025 rather than the combined 76818. Both patterns are legitimate when documentation matches the billing; what fails is billing 76818 and 59025 together, or billing 76819 plus 59025 when the tracing was actually folded into a single composite score.

When to use 76819 vs 76818
76819 · Without NST
  • Four ultrasound components scored
  • No tracing in the composite score
  • Pairs with a distinct 59025 when documented
  • Lower RVUs than the combined code
76818 · With NST
  • Five components including the tracing
  • NST bundled, never add 59025
  • Single composite score documented
  • Higher RVUs, one combined claim line

Documentation checklist

Document the four components and their scores, and keep the NST paperwork separate if 59025 is going on the claim.

✓ Surveillance indication documented
✓ Fetal breathing movements observed and scored
✓ Gross body movements observed and scored
✓ Fetal tone observed and scored
✓ Amniotic fluid volume measured and scored
✓ Composite score and interpretation, explicitly without an NST component
✓ If 59025 is billed same day, a separate NST report with its own interpretation
✓ Images stored and interpretation signed

Global package rules

76819 is antepartum surveillance, billed outside the global obstetric package and separately from 59400 on each date of service. Serial testing follows the same frequency logic as other surveillance codes: no CPT cap, but every claim carries the qualifying diagnosis. For twins, report per fetus with modifier 59 on additional-fetus lines and per-fetus scoring in the record. NCCI

TC-26 components

Like the full BPP, 76819 splits into professional and technical components. The interpreting physician bills 76819-26 when the facility owns the equipment; one entity providing both bills the global code.

76819
Global: one entity owns equipment and interpretation
76819-26
Professional: interpretation only
76819-TC
Technical: equipment and staff

Reimbursement

2026 · national Medicare averages
ComponentWork RVUTotal RVU2026 rate
76819Global0.752.63$87.84
76819-26Professional0.751.10$36.74
76819-TCTechnical0.001.53$51.10

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 59025 bundled into the BPP claim
Why it happens
The payer collapsed the same-day NST into the BPP, treating the pair as the combined service.
How to fix
When the NST was a distinct service with its own report, append modifier 59 to 59025 and appeal with both documents. If it was one composite test, rebill as 76818 alone.
Source: NCCI
CO-236 76819 and 76818 on the same date
Why it happens
Both BPP codes hit the claim for a single test.
How to fix
Bill one. The composite with tracing is 76818; the ultrasound-only score is 76819.
Source: NCCI
CO-50 No surveillance indication
Why it happens
The claim lacked a diagnosis supporting antepartum testing.
How to fix
Attach the high-risk condition driving the protocol and confirm the report states it. Routine testing of low-risk pregnancies is not covered.
Source: CMS
CO-151 Testing frequency exceeded
Why it happens
Serial claims crossed the payer's utilization threshold for the diagnosis.
How to fix
Appeal with the surveillance protocol and specialty guidance supporting the testing interval for the documented condition.
Source: ACOG/SMFM

FAQ

What is the CPT code description for 76819?
In plain language, 76819 covers the fetal biophysical profile scored on ultrasound findings alone: fetal breathing, body movement, tone, and amniotic fluid volume, without a non-stress test in the composite score.
Can I bill 76819 and 59025 together?
Yes, when the NST is a separately performed and separately documented service. Use modifier 59 on 59025 where the payer requires it. If the tracing was scored into the BPP composite, the correct billing is 76818 alone.
Which pays more, 76818 or 76819 plus 59025?
It varies by payer and setting, and choosing codes by reimbursement rather than by what was performed is the audit risk to avoid. Bill the code that matches the documented service structure.
What is a modified BPP and how is it coded?
A modified BPP is typically an NST plus an amniotic fluid check. There is no single code for it: the common pattern is 59025 for the tracing plus 76815 for the fluid assessment, not a BPP code, since the four-component ultrasound score was not performed.
How is 76819 billed for twins?
Per fetus, with modifier 59 on the additional-fetus lines and each fetus scored separately in the record.
Is 76819 part of the global OB package?
No. Antepartum surveillance is billed separately from 59400 on every date of service.
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.