CPT code 76856: Pelvic ultrasound, complete, nonobstetric2026 Medicare rate & RVUs in Missouri
Report this code for a complete nonobstetric pelvic ultrasound assessing pelvic organs, commonly for pelvic pain, abnormal bleeding, or a suspected mass.
Medicare pays $93.97–$101.32 for 76856 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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On this page 9 sections
What 76856 covers
This service is a complete ultrasound examination of the nonpregnant pelvis, most often performed transabdominally by a sonographer and interpreted by a physician. Common reasons include pelvic pain, abnormal uterine bleeding, suspected fibroids or ovarian cysts, and evaluation of a pelvic mass. The study typically assesses the uterus, endometrium, ovaries, adnexa, and other relevant pelvic structures, with saved images and a written interpretation.
Select the complete study when the examination evaluates the relevant pelvic structures rather than only a limited question or region. The report should identify the structures assessed and document findings supporting the medical need. A separately performed transvaginal nonobstetric examination may be reported with 76830 when the documentation supports both services. CMS recognizes professional and technical components: report modifier 26 for interpretation, TC for equipment and staff, or neither for the global service. The diagnostic imaging multiple procedure reduction applies to both the technical and professional components.
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 76856 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
$93.97 to $101.32
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $100.22 | Unavailable |
| Metropolitan St. Louis, MO | $101.32 | Unavailable |
| Rest of Missouri | $93.97 | Unavailable |
How the 76856 rate is calculated
Each of 76856’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 · 76856
RVUs × geographic indexes × conversion factor
Work0.67
0.67 RVUs× 1.000 GPCI
Practice expense2.43
2.43 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
3.1500
Conversion factor
$33.4009
Medicare rate
$105.21
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 76856
The CMS indicators that decide how 76856 is paid alongside other services.
CMS payment indicators · 76856
Pelvic ultrasound, complete, nonobstetric
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 4 | Diagnostic imaging reduction applies to the technical component (and professional component) of additional services. |
| 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
76856 without 26 · national office
$105.21
Pelvic ultrasound, complete, nonobstetric
76856-26 · Professional component
$32.40
Pays only the interpretation and report.
76856 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 76857Pelvic ultrasoundLimited or follow-up
- 76856 represents a complete pelvic examination; 76857 is for a limited study addressing a focused question or selected structures.
- 76830Pelvic ultrasoundTransvaginal, nonobstetric
- 76830 describes nonobstetric transvaginal imaging. It may accompany 76856 when both the transabdominal complete study and transvaginal examination are performed.
- 76817OB ultrasoundTransvaginal approach
- 76817 is for transvaginal obstetric ultrasound. Use 76856 for a complete nonobstetric pelvic study.
76856 billing questions
Can 76856 and 76830 be reported for the same encounter?
They may be reported together when both a complete pelvic ultrasound and a nonobstetric transvaginal examination are performed and documented. The report should support each service.
Which modifier identifies the interpretation only?
Append modifier 26 when billing only the physician's professional interpretation. Modifier TC identifies the technical portion; billing without either modifier represents the global service.
How does the imaging multiple procedure reduction affect this code?
CMS applies the diagnostic imaging multiple procedure reduction to both the professional and technical components when applicable.
What documentation supports a complete pelvic study?
Document the clinical reason, pelvic structures evaluated, saved images, and interpretation. The findings and scope should support a complete examination rather than a focused limited study.
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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