76825 Antepartum testing

CPT 76825

CPT 76825: Fetal EchocardiographyFetal Echocardiography

The short answer

Use 76825 for a complete fetal echocardiogram: a dedicated, detailed ultrasound evaluation of the fetal heart performed when congenital heart disease is suspected or the pregnancy carries cardiac risk factors. Doppler interrogation of the fetal heart is reported separately with 76827, and later reassessments use the follow-up codes 76826 and 76828.

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

When to use 76825

Report 76825 when the fetal heart gets its own complete study, beyond the cardiac views of an anatomy scan. Common triggers: an abnormal four-chamber or outflow view on 76805 or 76811, pregestational diabetes, a family history of congenital heart disease, certain medication exposures, an abnormal NT, or a fetal arrhythmia. The study is typically performed by MFM specialists or pediatric cardiologists, and payers often restrict it accordingly. A fetal echo is not a substitute for the anatomy scan, and the anatomy scan's cardiac views do not become a fetal echo just because they were thorough.

When to use 76825 vs 76827

76825 · Complete echo

Full structural cardiac evaluation
Chambers, valves, outflow tracts, rhythm
First complete study of the fetal heart
Follow-up studies use 76826

76827 · Doppler echo

Doppler flow interrogation of the heart
Spectral and color flow assessment
Reported with 76825 when both performed
Follow-up Doppler uses 76828

Documentation checklist

Payers restrict this code, so the report has to justify both the study and the credentials behind it.

✓ Qualifying indication documented: abnormal screening views, diabetes, family history, teratogen exposure, abnormal NT, or arrhythmia

✓ Complete structural survey of the fetal heart: situs, chambers, septa, valves, outflow tracts, great vessels

✓ Rhythm assessed and documented

✓ Referral on file where the payer requires one

✓ Performed or interpreted by a qualified specialist, typically MFM or pediatric cardiology

✓ Images stored for each required view

✓ Signed interpretation with findings and impression

✓ Separate documentation for Doppler interrogation when 76827 is also billed

Global package rules

76825 is billed outside the global obstetric package and separately from 59400. It is also separately reportable from the anatomy scan when both are performed, even on the same day, because the fetal echo is a distinct study of a single organ system. When Doppler interrogation is performed with the echo, add 76827; the pair is the standard complete-study claim in many fetal cardiology programs. For twins, report per fetus with modifier 59 on additional-fetus lines. NCCI

TC-26 components

Fetal echo splits like other imaging: modifier 26 for the interpretation, TC for the facility owning the equipment. Referral-center models where an outside specialist reads studies performed at the OB office are professional-component arrangements.

76825

Global: one entity owns equipment and interpretation

76825-26

Professional: interpretation only

76825-TC

Technical: equipment and sonographer

Reimbursement

2026 · national Medicare averages

Component	Work RVU	Total RVU	2026 rate
76825Global	1.63	7.84	$261.86
76825-26Professional	1.63	2.36	$78.83
76825-TCTechnical	0.00	5.48	$183.04

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-50 No qualifying indication for a fetal echo

Why it happens

The claim lacked a diagnosis that supports a dedicated cardiac study over the standard anatomy views.

How to fix

Link the indication: the abnormal screening finding, maternal diabetes, family history, or exposure. Attach the referral where one exists.

Source: ACOG/SMFM

N290 Rendering provider not credentialed

Why it happens

The payer restricts fetal echocardiography to MFM or pediatric cardiology and the rendering provider did not match.

How to fix

Confirm the payer's specialty policy and bill under the qualified interpreting physician's NPI, or refer the study to a credentialed program.

Source: CMS

CO-97 Bundled into the anatomy scan

Why it happens

The payer treated the fetal echo as part of a same-day 76805 or 76811.

How to fix

The echo is a distinct study with its own indication and element set. Appeal with both reports and the payer's own fetal echo policy.

Source: NCCI

CO-151 Repeat complete echo billed

Why it happens

A second 76825 hit a frequency edit; complete studies are generally once per pregnancy per fetus.

How to fix

Bill reassessments as 76826 for follow-up echo, with 76828 for follow-up Doppler. Reserve a repeat 76825 for a genuinely new complete study with a documented reason.

Source: CMS

CO-16 Missing or invalid TC-26 modifier

Why it happens

Component billing was expected but modifiers were missing or duplicated.

How to fix

Bill 76825-26 for the interpretation and 76825-TC for the technical component, one entity each.

Source: CMS

FAQ

What is the CPT code description for 76825?

In plain language, 76825 covers a complete fetal echocardiogram: a dedicated ultrasound study of the fetal heart's structure and rhythm, performed when there is a reason to suspect congenital heart disease or elevated cardiac risk.

Can I bill 76825 and 76827 together?

Yes. The complete echo and its Doppler interrogation are separate codes and are commonly billed together when both are performed and documented. The follow-up pair is 76826 plus 76828.

Can 76825 be billed with the anatomy scan?

Yes, when both studies are performed with separate documentation. The fetal echo does not replace 76805 or 76811, and thorough cardiac views inside an anatomy scan do not justify billing an echo.

Who can bill a fetal echocardiogram?

Most payers expect MFM specialists or pediatric cardiologists, and some restrict payment by specialty designation. General OB practices usually refer the study out. Check the payer's credentialing policy.

How is a fetal echo billed for twins?

Per fetus, with a complete study documented for each and modifier 59 on the additional-fetus lines.

Is 76825 part of the global OB package?

No. Fetal echocardiography is billed separately from 59400.

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.