© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 76813 refers to a specific ultrasound procedure performed on a pregnant uterus during the first trimester. This procedure utilizes real-time imaging technology to document the measurement of fetal nuchal translucency, which is a critical assessment in prenatal care. The ultrasound can be conducted using either a transabdominal or transvaginal approach, depending on the clinical situation and the preference of the healthcare provider. Real-time ultrasound scanning is a dynamic imaging technique that not only captures two-dimensional images of the fetus but also allows for the observation of movement over time, providing valuable insights into fetal development. Nuchal translucency is defined as the measurement of subcutaneous edema located in the fetal neck area, which is assessed by determining the maximum thickness of the sonographically lucent zone. This zone is measured between the inner surface of the fetal skin and the outer surface of the soft tissue that covers the cervical spine or occipital bone. An increased measurement of nuchal translucency during the first trimester can indicate potential chromosomal defects and genetic abnormalities, including conditions such as Down syndrome, trisomy 13 or 18, as well as various heart and great vessel anomalies and skeletal dysplasias. For billing purposes, CPT® Code 76813 is designated for the first or single gestation, while CPT® Code 76814 should be used for each additional gestation.
© Copyright 2025 Coding Ahead. All rights reserved.
The ultrasound procedure described by CPT® Code 76813 is indicated for the following conditions:
The procedure for CPT® Code 76813 involves several key steps that ensure accurate measurement and documentation of fetal nuchal translucency:
After the completion of the ultrasound procedure, the patient may be advised on the next steps based on the findings. If the nuchal translucency measurement is within normal limits, routine prenatal care will continue. However, if the measurement indicates increased risk for chromosomal abnormalities, the healthcare provider may discuss further diagnostic testing options, such as chorionic villus sampling (CVS) or amniocentesis. Patients are typically informed about the results of the ultrasound and any necessary follow-up appointments. It is also important for patients to be aware of any signs or symptoms that may require immediate medical attention following the procedure.
| Short Descr | OB US NUCHAL MEAS 1 GEST | Medium Descr | US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION | Long Descr | Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 03 - Procedure must be performed under the personal supervision of physician. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I3B - Echography/ultrasonography - abdomen/pelvis | MUE | 1 | CCS Clinical Classification | 197 - Other diagnostic ultrasound |
This is a primary code that can be used with these additional add-on codes.
| 76814 | Female Edit Addon Code MPFS Status: Active Code APC N ASC N1 PUB 100 CPT Assistant Article Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (List separately in addition to code for primary procedure) |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | GB | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2011-01-01 | Changed | Short description changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
Get instant expert-level medical coding assistance.