$81.47
Choose 76819 for an ultrasound biophysical profile without NST. Choose 76818 when NST is also performed as part of the profile.
On this page
CMS RVU26D · Effective 2026-10-01
76818 Fetal biophysical profile Medicare reimbursement rates in Iowa
Reports fetal surveillance combining ultrasound assessment of biophysical activity and amniotic fluid with a nonstress test for the evaluated fetus. Compare 76818 office and facility rates across CMS payment localities in Iowa.
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 76818 in Iowa?
Iowa 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
$113.24
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Obstetric ultrasound
About 76818: Fetal biophysical profile with NST
Reports fetal surveillance combining ultrasound assessment of biophysical activity and amniotic fluid with a nonstress test for the evaluated fetus.
This service combines real-time ultrasound assessment of fetal breathing, movement, tone, and amniotic fluid with a nonstress test (NST). An obstetric sonographer or other qualified imaging staff may acquire the ultrasound images, while the interpreting physician or qualified practitioner evaluates and documents the findings. The NST records fetal heart-rate response, typically in an obstetric imaging or fetal surveillance setting when a biophysical profile is ordered with heart-rate testing.
Report 76818 when the documented assessment includes both the ultrasound biophysical profile and NST; use 76819 when the profile is performed without NST. The record should support the fetal assessment, ultrasound findings, NST results, and interpretation. Modifier 26 identifies the professional interpretation, while modifier TC identifies the technical service, including equipment and staff. Reporting without either modifier represents the global service.
CMS billing rules for 76818
- 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.
Where the value comes from
- Work RVU1.02 · 28%
- Practice expense (office) RVU2.56 · 70%
- Malpractice RVU0.07 · 2%
1.9K
Medicare services in 2024 · #2500 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.
76818 compared with similar codes
Office rates for Iowa, from the same CMS release.
$45.20
59025 describes an NST without the ultrasound biophysical profile. When the NST is incorporated into the profile, 76818 describes the combined service.
$103.26
76816 reports a follow-up obstetric ultrasound assessment; it is not a biophysical profile with NST.
Compare 76818 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
Iowa →
Office / nonfacility
$113.24
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 76818 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
8,796
- Code
- 76818
- Physician work
- 1.02
- Practice expense
- 2.56
- Malpractice
- 0.07
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.02 | × 1.000 | 1.0200 |
| Practice expense | 2.56 | × 0.915 | 2.3424 |
| Malpractice | 0.07 | × 0.397 | 0.0278 |
| Total RVUs | 3.3902 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$113.24
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.02 | 1 |
| Practice expense | 2.56 | 0.915 |
| Malpractice | 0.07 | 0.397 |
(1.02 × 1 + 2.56 × 0.915 + 0.07 × 0.397) × $33.4009 = $113.24
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.
76818 billing questions
How is 76818 different from 76819?
76818 includes an NST along with the ultrasound biophysical profile. Use 76819 when the profile is performed without an NST.
Can the NST also be reported as 59025?
The NST is part of 76818 when it is performed as the NST component of that biophysical profile. Do not separately report 59025 for that same NST service.
What do modifiers 26 and TC represent?
Modifier 26 identifies the professional interpretation. Modifier TC identifies the technical service, including equipment and staff; without either modifier, the claim represents the global service.
What documentation supports 76818?
Document the ultrasound biophysical findings, amniotic fluid assessment, NST results, and the interpreting professional’s conclusion. The record should show that both ultrasound assessment and NST were performed.
Is 76818 reported per fetus or by time?
The service is a fetal assessment, not a timed service. Document which fetus or fetuses were assessed and the work performed for each.
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.
8,79376817,,Transvaginal us obstetric,A,,0.73,2.00,,2.00,NA,0.05,2.78,2.78,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,3.47,3.47,0.06
8,79476817,26,Transvaginal us obstetric,A,,0.73,0.29,,0.29,,0.04,1.06,1.06,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8,79576817,TC,Transvaginal us obstetric,A,,0.00,1.71,,1.71,NA,0.01,1.72,1.72,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,3.18,3.18,0.02
8,79676818,,Fetal biophys profile w/nst,A,,1.02,2.56,,2.56,NA,0.07,3.65,3.65,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,3.60,3.60,0.08
8,79776818,26,Fetal biophys profile w/nst,A,,1.02,0.43,,0.43,,0.05,1.50,1.50,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8,79876818,TC,Fetal biophys profile w/nst,A,,0.00,2.13,,2.13,NA,0.02,2.15,2.15,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,3.17,3.17,0.03
8,79976819,,Fetal biophys profil w/o nst,A,,0.75,1.82,,1.82,NA,0.06,2.63,2.63,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,3.47,3.47,0.08
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136