CPT code 76816: Obstetric ultrasound, follow-up, each fetus2026 Medicare rate & RVUs in Maryland
Reports a transabdominal follow-up ultrasound to reassess fetal growth, amniotic fluid, or a previously evaluated pregnancy finding for each fetus.
Medicare pays $112.35–$127.48 for 76816 in the office in Maryland, from Rest of Maryland to Washington, DC area. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 76816 covers
CPT 76816 covers a transabdominal follow-up ultrasound of the pregnant uterus, reported for each fetus evaluated. It is commonly used when a clinician needs interval assessment of fetal growth or amniotic fluid, such as during surveillance for suspected growth concerns or after a prior study identified a finding requiring reassessment. An obstetrician, maternal-fetal medicine specialist, or radiologist may perform and interpret the diagnostic study; a sonographer may acquire the images under the provider’s direction.
Report this code for a follow-up examination, not as a substitute for a complete initial survey or a limited examination addressing a narrower question. The record should support the reason for reassessment and document the fetus-specific measurements and findings, with the interpretation and image documentation. CMS recognizes separately priced professional and technical components: modifier 26 identifies interpretation, modifier TC identifies equipment and staff, and billing without either modifier represents the global service.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 76816 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$112.35 to $127.48
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $118.04 | Unavailable |
| Rest of Maryland | $112.35 | Unavailable |
| Washington, DC area | $127.48 | Unavailable |
How the 76816 rate is calculated
Each of 76816’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 76816
RVUs × geographic indexes × conversion factor
Work0.83
0.83 RVUs× 1.000 GPCI
Practice expense2.45
2.45 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
3.3300
Conversion factor
$33.4009
Medicare rate
$111.22
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 76816
The CMS indicators that decide how 76816 is paid alongside other services.
CMS payment indicators · 76816
Obstetric ultrasound, follow-up, each fetus
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
76816 without 26 · national office
$111.22
Obstetric ultrasound, follow-up, each fetus
76816-26 · Professional component
$40.75
Pays only the interpretation and report.
76816 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 76805Obstetric ultrasoundSingle fetus, 14 weeks or later
- 76805 is the standard complete obstetric survey; 76816 is a follow-up study reassessing growth, fluid, or a previously evaluated finding.
- 76815Obstetric ultrasoundLimited assessment
- 76815 is limited to a focused question or portion of the examination. Choose 76816 when the service is a follow-up reassessment rather than a limited study.
- 76811Obstetric ultrasoundDetailed single gestation
- 76811 is a detailed fetal anatomic examination. It is selected for that comprehensive targeted survey, not simply for interval monitoring.
- 76810Obstetric ultrasound14 weeks or later
- 76810 covers a standard complete survey of an additional fetus; 76816 reports follow-up reassessment for each fetus evaluated.
76816 billing questions
When should 76816 be chosen over 76815?
Use 76816 for a follow-up assessment such as interval fetal growth or amniotic fluid reassessment. Use 76815 when the service is a limited examination focused on a narrower question.
How is 76816 reported for a multiple gestation?
The service is reported per fetus evaluated. Documentation should make clear which fetus or fetuses received the follow-up assessment.
How do modifiers 26 and TC affect this code?
Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service, including equipment and staff. Without either modifier, the claim represents the global service.
How does 76816 differ from 76805?
CPT 76805 describes a standard complete obstetric ultrasound, while 76816 is for a follow-up reassessment. Select based on the examination performed and its purpose, not simply because the patient has had an earlier scan.
What documentation supports a follow-up study?
Document the clinical reason for reassessment, the fetus evaluated, relevant measurements and findings, and the interpreting provider’s report. The record should show that the service was a follow-up rather than a limited or complete initial survey.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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