CPT code 76946: Amniocentesis guidance, ultrasound needle guidance2026 Medicare rate & RVUs in North Carolina
Reports real-time ultrasound guidance used to direct an amniocentesis needle into the amniotic cavity during prenatal diagnostic sampling.
In North Carolina, Medicare pays $32.32 for 76946 in the office.
Check a contract rate as a % of Medicare · 76946 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 76946 covers
This service uses real-time ultrasound to help guide the needle into the amniotic cavity during amniocentesis, commonly for prenatal diagnostic sampling. The operator uses imaging to assess the needle path and its position during the procedure. Obstetricians, maternal-fetal medicine specialists, and radiologists may perform the guidance in an office or hospital setting.
Report this guidance with the amniocentesis service when both are performed; the amniocentesis itself is reported separately. Documentation should identify the guidance performed and include the interpreting clinician’s findings. CMS recognizes professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies the equipment and staff, and reporting without either modifier represents the global service. Use the component modifier that matches how the service was furnished and billed.
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.
How North Carolina compares for 76946
Across 109 of 109 payment localities, the office rate for 76946 runs from $30.66 in Arkansas to $44.12 in San Benito County, CA. North Carolina pays $32.32. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Carolina · this page$32.32
- Los Angeles, CA · California$38.03+$5.71
- Washington, DC area · District of Columbia$38.54+$6.22
- Miami, FL · Florida$36.45+$4.13
- Chicago, IL · Illinois$35.56+$3.24
- Manhattan, NY · New York$38.80+$6.48
- Alaska · Alaska$41.14+$8.82
Other areas in North Carolina first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $31.05 | — |
| ArkansasArkansas | $30.66 | — |
| ArizonaArizona | $33.28 | — |
| Bakersfield, CACalifornia | $35.90 | — |
| Chico, CACalifornia | $35.80 | — |
| El Centro, CACalifornia | $35.81 | — |
| Fresno, CACalifornia | $35.80 | — |
| Hanford, CACalifornia | $35.80 | — |
| Madera, CACalifornia | $35.80 | — |
| Merced, CACalifornia | $35.80 | — |
| Modesto, CACalifornia | $35.80 | — |
| Napa, CACalifornia | $40.94 | — |
| Oxnard, CACalifornia | $37.81 | — |
| Redding, CACalifornia | $35.80 | — |
| Rest of CaliforniaCalifornia | $35.80 | — |
| Riverside, CACalifornia | $36.13 | — |
| Sacramento, CACalifornia | $37.42 | — |
| Salinas, CACalifornia | $37.28 | — |
| San Diego, CACalifornia | $38.04 | — |
| Marin County, CACalifornia | $43.19 | — |
| San Francisco, CACalifornia | $43.16 | — |
| San Benito County, CACalifornia | $44.12 | — |
| Santa Clara County, CACalifornia | $43.98 | — |
| San Luis Obispo, CACalifornia | $36.69 | — |
| Santa Cruz, CACalifornia | $38.32 | — |
| Santa Maria, CACalifornia | $37.39 | — |
| Santa Rosa, CACalifornia | $38.70 | — |
| Stockton, CACalifornia | $35.80 | — |
| Vallejo, CACalifornia | $40.89 | — |
| Visalia, CACalifornia | $35.80 | — |
| Yuba City, CACalifornia | $35.80 | — |
| ColoradoColorado | $35.32 | — |
| ConnecticutConnecticut | $36.12 | — |
| DelawareDelaware | $33.78 | — |
| Fort Lauderdale, FLFlorida | $35.15 | — |
| Rest of FloridaFlorida | $33.66 | — |
| Atlanta, GAGeorgia | $34.64 | — |
| Rest of GeorgiaGeorgia | $32.02 | — |
| Hawaii, Guam, HIHawaii | $36.48 | — |
| IowaIowa | $31.70 | — |
| IdahoIdaho | $31.88 | — |
| East St. Louis, ILIllinois | $33.43 | — |
| Rest of IllinoisIllinois | $32.83 | — |
| Suburban Chicago, ILIllinois | $35.49 | — |
| IndianaIndiana | $32.04 | — |
| KansasKansas | $31.58 | — |
| KentuckyKentucky | $31.69 | — |
| New Orleans, LALouisiana | $32.98 | — |
| Rest of LouisianaLouisiana | $31.65 | — |
| Metropolitan Boston, MAMassachusetts | $38.48 | — |
| Rest of MassachusettsMassachusetts | $35.16 | — |
| Baltimore area, MDMaryland | $36.02 | — |
| Rest of MarylandMaryland | $34.36 | — |
| Rest of MaineMaine | $32.03 | — |
| Southern Maine, MEMaine | $33.51 | — |
| Detroit, MIMichigan | $34.03 | — |
| Rest of MichiganMichigan | $32.40 | — |
| MinnesotaMinnesota | $33.96 | — |
| Metropolitan Kansas City, MOMissouri | $32.78 | — |
| Metropolitan St. Louis, MOMissouri | $33.08 | — |
| Rest of MissouriMissouri | $31.19 | — |
| MississippiMississippi | $30.93 | — |
| MontanaMontana | $34.07 | — |
| North DakotaNorth Dakota | $33.47 | — |
| NebraskaNebraska | $31.85 | — |
| New HampshireNew Hampshire | $34.79 | — |
| Northern New JerseyNew Jersey | $38.23 | — |
| Rest of New JerseyNew Jersey | $36.57 | — |
| New MexicoNew Mexico | $32.55 | — |
| NevadaNevada | $33.92 | — |
| NYC suburbs and Long Island, NYNew York | $39.63 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $36.80 | — |
| Queens, NYNew York | $39.07 | — |
| Rest of New YorkNew York | $32.74 | — |
| OhioOhio | $32.28 | — |
| OklahomaOklahoma | $31.63 | — |
| Portland, OROregon | $36.31 | — |
| Rest of OregonOregon | $33.69 | — |
| Metropolitan Philadelphia, PAPennsylvania | $35.33 | — |
| Rest of PennsylvaniaPennsylvania | $32.32 | — |
| Puerto RicoPuerto Rico | $34.28 | — |
| Rhode IslandRhode Island | $34.88 | — |
| South CarolinaSouth Carolina | $32.34 | — |
| South DakotaSouth Dakota | $33.40 | — |
| TennesseeTennessee | $31.72 | — |
| Austin, TXTexas | $35.18 | — |
| Beaumont, TXTexas | $32.13 | — |
| Brazoria, TXTexas | $33.76 | — |
| Dallas, TXTexas | $33.96 | — |
| Fort Worth, TXTexas | $33.76 | — |
| Galveston, TXTexas | $33.85 | — |
| Houston, TXTexas | $34.40 | — |
| Rest of TexasTexas | $32.92 | — |
| UtahUtah | $32.72 | — |
| VirginiaVirginia | $33.42 | — |
| Virgin Islands, VIUnited States Virgin Islands | $34.28 | — |
| VermontVermont | $33.37 | — |
| Rest of WashingtonWashington | $35.09 | — |
| King County, WAWashington | $39.20 | — |
| WisconsinWisconsin | $32.51 | — |
| West VirginiaWest Virginia | $31.79 | — |
| WyomingWyoming | $33.81 | — |
76946 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$30.66
$41.14
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $41.14 | 1 |
| AL | $31.05 | 1 |
| AR | $30.66 | 1 |
| AZ | $33.28 | 1 |
| CA | $35.80–$44.12 | 29 |
| CO | $35.32 | 1 |
| CT | $36.12 | 1 |
| DC | $38.54 | 1 |
| DE | $33.78 | 1 |
| FL | $33.66–$36.45 | 3 |
| GA | $32.02–$34.64 | 2 |
| GU | $36.48 | 1 |
| HI | $36.48 | 1 |
| IA | $31.70 | 1 |
| ID | $31.88 | 1 |
| IL | $32.83–$35.56 | 4 |
| IN | $32.04 | 1 |
| KS | $31.58 | 1 |
| KY | $31.69 | 1 |
| LA | $31.65–$32.98 | 2 |
| MA | $35.16–$38.48 | 2 |
| MD | $34.36–$38.54 | 3 |
| ME | $32.03–$33.51 | 2 |
| MI | $32.40–$34.03 | 2 |
| MN | $33.96 | 1 |
| MO | $31.19–$33.08 | 3 |
| MS | $30.93 | 1 |
| MT | $34.07 | 1 |
| NC | $32.32 | 1 |
| ND | $33.47 | 1 |
| NE | $31.85 | 1 |
| NH | $34.79 | 1 |
| NJ | $36.57–$38.23 | 2 |
| NM | $32.55 | 1 |
| NV | $33.92 | 1 |
| NY | $32.74–$39.63 | 5 |
| OH | $32.28 | 1 |
| OK | $31.63 | 1 |
| OR | $33.69–$36.31 | 2 |
| PA | $32.32–$35.33 | 2 |
| PR | $34.28 | 1 |
| RI | $34.88 | 1 |
| SC | $32.34 | 1 |
| SD | $33.40 | 1 |
| TN | $31.72 | 1 |
| TX | $32.13–$35.18 | 8 |
| UT | $32.72 | 1 |
| VA | $33.42–$38.54 | 2 |
| VI | $34.28 | 1 |
| VT | $33.37 | 1 |
| WA | $35.09–$39.20 | 2 |
| WI | $32.51 | 1 |
| WV | $31.79 | 1 |
| WY | $33.81 | 1 |
How the 76946 rate is calculated
Each of 76946’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 · 76946
RVUs × geographic indexes × conversion factor
Work0.37
0.37 RVUs× 1.000 GPCI
Practice expense0.62
0.62 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
1.0200
Conversion factor
$33.4009
Medicare rate
$34.07
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact North Carolina inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
8,877
- Code
- 76946
- Physician work
- 0.37
- Practice expense
- 0.62
- Malpractice
- 0.03
GPCI2026.csv
83
- Locality
- North Carolina
- Physician work
- 1.000
- Practice expense
- 0.933
- Malpractice
- 0.639
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.37 | × 1.000 | 0.3700 |
| Practice expense | 0.62 | × 0.933 | 0.5785 |
| Malpractice | 0.03 | × 0.639 | 0.0192 |
| Total RVUs | 0.9676 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Carolina$32.32
Office: (0.37 × 1 + 0.62 × 0.933 + 0.03 × 0.639) × $33.4009 = $32.32
Payment rules and modifiers for 76946
The CMS indicators that decide how 76946 is paid alongside other services.
CMS payment indicators · 76946
Amniocentesis guidance, ultrasound needle guidance
| 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
76946 without 26 · national office
$34.07
Amniocentesis guidance, ultrasound needle guidance
76946-26 · Professional component
$18.37
Pays only the interpretation and report.
How 76946 has changed in North Carolina
76946 · Office / nonfacility
$32.32
Effective 2026-10-01
The base rate is $1.63 higher than on 2025-10-01, moving from $30.69 to $32.32 (5.3%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$30.69changed to$32.32
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.38 changed to 0.37
- Practice expense RVU 0.60 changed to 0.62
- Malpractice RVU 0.02 changed to 0.03
- Practice expense GPCI 0.926 changed to 0.933
- Malpractice GPCI 0.665 changed to 0.639
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$31.59changed to$30.69
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$31.07changed to$31.59
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$31.60changed to$31.07
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.58 changed to 0.60
- Practice expense GPCI 0.927 changed to 0.926
- Malpractice GPCI 0.742 changed to 0.665
January 1, 2023
RVU23A
$31.38changed to$31.60
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.55 changed to 0.58
- Practice expense GPCI 0.928 changed to 0.927
- Malpractice GPCI 0.819 changed to 0.742
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$31.64changed to$31.38
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$31.38changed to$31.64
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.51 changed to 0.55
- Practice expense GPCI 0.930 changed to 0.928
- Malpractice GPCI 0.757 changed to 0.819
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$31.47changed to$31.38
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.50 changed to 0.51
- Malpractice RVU 0.04 changed to 0.02
- Practice expense GPCI 0.931 changed to 0.930
- Malpractice GPCI 0.695 changed to 0.757
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$31.77changed to$31.47
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.51 changed to 0.50
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$31.73changed to$31.77
- Conversion factor 35.8887 changed to 35.9996
- Malpractice GPCI 0.732 changed to 0.695
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$31.69changed to$31.73
- Conversion factor 35.8043 changed to 35.8887
- Practice expense GPCI 0.930 changed to 0.931
- Malpractice GPCI 0.768 changed to 0.732
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$31.80changed to$31.69
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$31.64changed to$31.80
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$31.11changed to$31.64
- Conversion factor 35.8228 changed to 35.7547
- Malpractice RVU 0.02 changed to 0.04
- Practice expense GPCI 0.929 changed to 0.930
- Malpractice GPCI 0.732 changed to 0.768
Held through RVU15B.
January 1, 2014
RVU14A
$31.06changed to$31.11
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 0.56 changed to 0.51
- Practice expense GPCI 0.927 changed to 0.929
- Malpractice GPCI 0.695 changed to 0.732
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $31.06
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $32.32 | Not available in this setting | RVU26D |
| 2026-07-01 | $32.32 | Not available in this setting | RVU26C |
| 2026-04-01 | $32.32 | Not available in this setting | RVU26B |
| 2026-01-01 | $32.32 | Not available in this setting | RVU26A |
| 2025-10-01 | $30.69 | Not available in this setting | RVU25D |
| 2025-07-01 | $30.69 | Not available in this setting | RVU25C |
| 2025-04-01 | $30.69 | Not available in this setting | RVU25B |
| 2025-01-01 | $30.69 | Not available in this setting | RVU25A |
| 2024-10-01 | $31.59 | Not available in this setting | RVU24D |
| 2024-07-01 | $31.59 | Not available in this setting | RVU24C |
| 2024-04-01 | $31.59 | Not available in this setting | RVU24B |
| 2024-03-09 | $31.59 | Not available in this setting | RVU24AR |
| 2024-01-01 | $31.07 | Not available in this setting | RVU24A |
| 2023-10-01 | $31.60 | Not available in this setting | RVU23D |
| 2023-07-01 | $31.60 | Not available in this setting | RVU23C |
| 2023-04-01 | $31.60 | Not available in this setting | RVU23B |
| 2023-01-01 | $31.60 | Not available in this setting | RVU23A |
| 2022-10-01 | $31.38 | Not available in this setting | RVU22D |
| 2022-07-01 | $31.38 | Not available in this setting | RVU22C |
| 2022-04-01 | $31.38 | Not available in this setting | RVU22B |
| 2022-01-01 | $31.38 | Not available in this setting | RVU22A |
| 2021-10-01 | $31.64 | Not available in this setting | RVU21D |
| 2021-07-01 | $31.64 | Not available in this setting | RVU21C |
| 2021-04-01 | $31.64 | Not available in this setting | RVU21B |
| 2021-01-01 | $31.64 | Not available in this setting | RVU21A |
| 2020-10-01 | $31.38 | Not available in this setting | RVU20D |
| 2020-07-01 | $31.38 | Not available in this setting | RVU20C |
| 2020-04-01 | $31.38 | Not available in this setting | RVU20B |
| 2020-01-01 | $31.38 | Not available in this setting | RVU20A |
| 2019-10-01 | $31.47 | Not available in this setting | RVU19D |
| 2019-07-01 | $31.47 | Not available in this setting | RVU19C |
| 2019-04-01 | $31.47 | Not available in this setting | RVU19B |
| 2019-01-01 | $31.47 | Not available in this setting | RVU19A |
| 2018-10-01 | $31.77 | Not available in this setting | RVU18D |
| 2018-07-01 | $31.77 | Not available in this setting | RVU18C |
| 2018-04-01 | $31.77 | Not available in this setting | RVU18B |
| 2018-01-01 | $31.77 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $31.73 | Not available in this setting | RVU17D |
| 2017-07-01 | $31.73 | Not available in this setting | RVU17C |
| 2017-04-01 | $31.73 | Not available in this setting | RVU17B |
| 2017-01-01 | $31.73 | Not available in this setting | RVU17A |
| 2016-10-01 | $31.69 | Not available in this setting | RVU16D |
| 2016-07-01 | $31.69 | Not available in this setting | RVU16C |
| 2016-04-01 | $31.69 | Not available in this setting | RVU16B |
| 2016-01-01 | $31.69 | Not available in this setting | RVU16A |
| 2015-10-01 | $31.80 | Not available in this setting | RVU15D |
| 2015-07-01 | $31.80 | Not available in this setting | RVU15C |
| 2015-04-01 | $31.64 | Not available in this setting | RVU15B |
| 2015-01-01 | $31.64 | Not available in this setting | RVU15A |
| 2014-10-01 | $31.11 | Not available in this setting | RVU14D |
| 2014-07-01 | $31.11 | Not available in this setting | RVU14C |
| 2014-04-01 | $31.11 | Not available in this setting | RVU14B |
| 2014-01-01 | $31.11 | Not available in this setting | RVU14A |
| 2013-10-01 | $31.06 | Not available in this setting | RVU13D |
| 2013-07-01 | $31.06 | Not available in this setting | RVU13C |
| 2013-04-01 | $31.06 | Not available in this setting | RVU13B |
| 2013-01-01 | $31.06 | Not available in this setting | RVU13AR |
Where the North Carolina rate applies
North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Advance
- Ahoskie
- Alamance
- Albemarle
- Alexis
- Alliance
- Altamahaw
76946 billing questions
Which amniocentesis code is commonly reported with this guidance?
CPT 59000 represents the amniocentesis procedure and is commonly reported for the sampling performed during the same encounter. This code represents the ultrasound guidance.
How is this different from ultrasound guidance for chorionic villus sampling?
Use 76946 for ultrasound guidance during amniocentesis. Code 76945 is for guidance during chorionic villus sampling, a different prenatal sampling procedure.
When should modifier 26 or TC be used?
Use modifier 26 for the professional interpretation and modifier TC for the technical service, including equipment and staff. Without either modifier, the claim represents the global service.
Does this code represent a complete obstetric ultrasound examination?
No. It describes ultrasound guidance for the amniocentesis needle, not a comprehensive fetal or obstetric examination.
What documentation supports reporting the guidance?
Document that ultrasound was used to guide the amniocentesis, along with the guidance findings and the interpreting clinician’s report. The record should support the component billed when professional and technical services are split.
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
Show the CMS file lines behind this rate
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