CPT code 76801: Obstetric ultrasound2026 Medicare rate & RVUs in Illinois
Reports a complete ultrasound assessment of a single or first pregnancy before 14 weeks, including early fetal and pregnancy evaluation.
Medicare pays $110.85–$120.90 for 76801 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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.
On this page 9 sections
What 76801 covers
This code describes a complete ultrasound assessment of a pregnancy before 14 weeks for a single fetus or the first fetus in a multiple gestation. It is commonly performed in an obstetric office, radiology department, or maternal-fetal medicine setting to assess early pregnancy, such as dating or viability concerns. The examination may document the gestational sac, embryo, cardiac activity, fetal measurements, and relevant maternal structures. An obstetrician, radiologist, or maternal-fetal medicine specialist may interpret the images.
Select this code for a complete early obstetric study, rather than a limited check or a focused follow-up examination. The report should support the gestational age, number of fetuses, images and findings assessed, and the clinical reason for the study. For additional fetuses, report the applicable additional-fetus code with the primary study. CMS recognizes professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies equipment and staff, and reporting without a 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 76801 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$110.85 to $120.90
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $120.14 | Unavailable |
| East St. Louis | $112.34 | Unavailable |
| Rest Of Illinois | $110.85 | Unavailable |
| Suburban Chicago | $120.90 | Unavailable |
How the 76801 rate is calculated
Each of 76801’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 · 76801
RVUs × geographic indexes × conversion factor
Work0.97
0.97 RVUs× 1.000 GPCI
Practice expense2.47
2.47 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
3.5000
Conversion factor
$33.4009
Medicare rate
$116.90
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 76801
The CMS indicators that decide how 76801 is paid alongside other services.
CMS payment indicators · 76801
Obstetric ultrasound
| 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
76801 without 26 · national office
$116.90
Obstetric ultrasound
76801-26 · Professional component
$46.43
Pays only the interpretation and report.
76801 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 76802Obstetric ultrasound
- 76801 covers the first fetus in the early complete study; 76802 reports the additional-fetus portion of a multiple-gestation examination.
- 76805Obstetric ultrasound
- 76805 is the complete single-fetus obstetric study for pregnancies at 14 weeks or later; 76801 is for before 14 weeks.
- 76811Obstetric ultrasound
- 76811 is for a detailed fetal anatomic examination, not the routine complete early pregnancy assessment represented by 76801.
- 76815Obstetric ultrasound
- 76815 represents a limited obstetric ultrasound; 76801 is selected when a complete early obstetric examination is performed.
76801 billing questions
When is 76801 reported instead of 76815?
Use 76801 for a complete early obstetric ultrasound before 14 weeks. A limited examination addressing a narrower question is represented by 76815.
How is an additional fetus reported?
For a multiple gestation, report 76801 for the first fetus and 76802 for each additional fetus when the additional-fetus study is performed.
What do modifiers 26 and TC identify?
Modifier 26 reports the professional interpretation, while TC reports the technical service, including equipment and staff. Without either modifier, the claim represents the global service.
What documentation supports 76801?
Document the indication, gestational age, number of fetuses, examination performed, images and findings, and the interpretation. The record should support a complete early pregnancy assessment rather than a limited or focused study.
How does 76801 differ from 76817?
76801 represents a complete early obstetric ultrasound. 76817 is used for an obstetric ultrasound performed by the transvaginal approach; the approach and service performed should be clear in the record.
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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