CPT code 76819: Biophysical profile, without nonstress test2026 Medicare rate & RVUs in Missouri
Reports ultrasound assessment of fetal breathing, movement, tone, and amniotic fluid when a biophysical profile is performed without an NST.
Medicare pays $79.40–$84.93 for 76819 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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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What 76819 covers
This antepartum ultrasound evaluates fetal breathing movements, gross body movement, fetal tone, and amniotic fluid volume without including a nonstress test. Obstetricians, maternal-fetal medicine specialists, or qualified imaging staff typically perform or interpret it during surveillance of pregnancies with concerns such as decreased fetal movement, maternal diabetes or hypertension, fetal growth restriction, or a post-term pregnancy.
Report 76819 when the documented service includes the ultrasound components of a biophysical profile and no NST is part of that service. The record should support the clinical reason, the fetal observations and fluid assessment, and the interpreting clinician’s findings. CMS recognizes professional and technical portions: report modifier 26 for interpretation, modifier TC for equipment and staff, or no component modifier when billing 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 76819 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$79.40 to $84.93
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $84.09 | Unavailable |
| Metropolitan St. Louis, MO | $84.93 | Unavailable |
| Rest of Missouri | $79.40 | Unavailable |
How the 76819 rate is calculated
Each of 76819’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 · 76819
RVUs × geographic indexes × conversion factor
Work0.75
0.75 RVUs× 1.000 GPCI
Practice expense1.82
1.82 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
2.6300
Conversion factor
$33.4009
Medicare rate
$87.84
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 76819
The CMS indicators that decide how 76819 is paid alongside other services.
CMS payment indicators · 76819
Biophysical profile, without nonstress test
| 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
76819 without 26 · national office
$87.84
Biophysical profile, without nonstress test
76819-26 · Professional component
$36.74
Pays only the interpretation and report.
76819 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 76818Fetal biophysical profileWith nonstress test
- 76819 covers the ultrasound profile without an NST; 76818 includes the NST along with the profile.
- 76816Obstetric ultrasoundFollow-up, each fetus
- 76816 is a follow-up obstetric ultrasound focused on fetal growth or anatomy. It is not the four-part ultrasound assessment used for a biophysical profile.
- 76820Umbilical artery DopplerFetal Doppler velocimetry
- 76820 evaluates umbilical artery blood flow with Doppler. It is a vascular assessment, not the ultrasound components of a biophysical profile.
76819 billing questions
When should 76819 be chosen over 76818?
Use 76819 for the ultrasound components of a biophysical profile without an NST. Use 76818 when the service also includes the NST.
Which portions can be billed separately?
The professional interpretation may be reported with modifier 26, and the technical service with modifier TC. Billing without either modifier represents the global service.
What documentation supports 76819?
Document the reason for surveillance, findings for fetal breathing, movement, tone, and amniotic fluid, and the interpreting clinician’s conclusion. The service should not include an NST.
Is the NST included in 76819?
No. This code represents the ultrasound profile without an NST; 76818 represents a profile that includes one.
Can a fetal Doppler study be reported with 76819?
A separately performed and documented Doppler assessment, such as umbilical artery flow evaluation, may be reported when it is also clinically indicated.
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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