Coding and reimbursement for full, follow-up and limited pregnancy ultrasounds

Q.

Is it correct that CPT^® code 76805 is for an initial ultrasound (US) and should be used only once, all subsequent ultrasounds would be coded with 76815 or 76816 depending on the indication?

A.

Most insurances allow only one complete US per pregnancy, whether 76801 or 76805 and all others are either follow-up or limited. That is also the guidance from AMA in several questions/answers and articles. The only exception might be if 76801 or 76805 shows something that requires 76811 for level 3 high-risk US, but that should be rare. The codes and full descriptions are as follows:

76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation

76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation

76815 Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., fetal heartbeat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses

76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (e.g., re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus