$47.98
76856 represents a complete pelvic examination; 76857 is for a limited study addressing a focused question or selected structures.
On this page
CMS RVU26D · Effective 2026-10-01
76856 Pelvic ultrasound Medicare reimbursement rates in Indiana
Report this code for a complete nonobstetric pelvic ultrasound assessing pelvic organs, commonly for pelvic pain, abnormal bleeding, or a suspected mass. Compare 76856 office and facility rates across CMS payment localities in Indiana.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 76856 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$98.43
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Diagnostic imaging
About 76856: Complete nonobstetric pelvic ultrasound
Report this code for a complete nonobstetric pelvic ultrasound assessing pelvic organs, commonly for pelvic pain, abnormal bleeding, or a suspected mass.
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.
CMS billing rules for 76856
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
- Multiple procedures
- Diagnostic imaging multiple procedure reduction applies to the technical and professional components.
Where the value comes from
- Work RVU0.67 · 21%
- Practice expense (office) RVU2.43 · 77%
- Malpractice RVU0.05 · 2%
364.1K
Medicare services in 2024 · #276 by national volume
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.
76856 compared with similar codes
Office rates for Indiana, from the same CMS release.
$109.74
76830 describes nonobstetric transvaginal imaging. It may accompany 76856 when both the transabdominal complete study and transvaginal examination are performed.
$87.12
76817 is for transvaginal obstetric ultrasound. Use 76856 for a complete nonobstetric pelvic study.
Compare 76856 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Indiana →
Office / nonfacility
$98.43
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 76856 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
8,826
- Code
- 76856
- Physician work
- 0.67
- Practice expense
- 2.43
- Malpractice
- 0.05
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.67 | × 1.000 | 0.6700 |
| Practice expense | 2.43 | × 0.927 | 2.2526 |
| Malpractice | 0.05 | × 0.486 | 0.0243 |
| Total RVUs | 2.9469 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$98.43
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.67 | 1 |
| Practice expense | 2.43 | 0.927 |
| Malpractice | 0.05 | 0.486 |
(0.67 × 1 + 2.43 × 0.927 + 0.05 × 0.486) × $33.4009 = $98.43
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
8,82376831,,Echo exam uterus,A,,0.70,2.76,,2.76,NA,0.05,3.51,3.51,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,7.57,7.57,0.07
8,82476831,26,Echo exam uterus,A,,0.70,0.30,,0.30,,0.04,1.04,1.04,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,0.00,0.00,0.00
8,82576831,TC,Echo exam uterus,A,,0.00,2.46,,2.46,NA,0.01,2.47,2.47,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,03,0,88,7.27,7.27,0.03
8,82676856,,Us exam pelvic complete,A,,0.67,2.43,,2.43,NA,0.05,3.15,3.15,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,3.44,3.44,0.05
8,82776856,26,Us exam pelvic complete,A,,0.67,0.26,,0.26,,0.04,0.97,0.97,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,0.00,0.00,0.00
8,82876856,TC,Us exam pelvic complete,A,,0.00,2.17,,2.17,NA,0.01,2.18,2.18,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,01,0,88,3.18,3.18,0.01
8,82976857,,Us exam pelvic limited,A,,0.49,1.00,,1.00,NA,0.04,1.53,1.53,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,3.35,3.35,0.07
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915