$125.13
76819 covers the ultrasound profile without an NST; 76818 includes the NST along with the profile.
On this page
CMS RVU26D · Effective 2026-10-01
76819 Biophysical profile Medicare reimbursement rates in Rhode Island
Reports ultrasound assessment of fetal breathing, movement, tone, and amniotic fluid when a biophysical profile is performed without an NST. Compare 76819 office and facility rates across CMS payment localities in Rhode Island.
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 76819 in Rhode Island?
Rhode Island 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
$90.11
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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 76819: Fetal biophysical profile without NST
Reports ultrasound assessment of fetal breathing, movement, tone, and amniotic fluid when a biophysical profile is performed without an NST.
This antepartum ultrasound evaluates fetal breathing movements, gross body movement, fetal tone, and amniotic fluid volume without including a nonstress test. Obstetricians, maternal-fetal medicine specialists, or qualified imaging staff typically perform or interpret it during surveillance of pregnancies with concerns such as decreased fetal movement, maternal diabetes or hypertension, fetal growth restriction, or a post-term pregnancy.
Report 76819 when the documented service includes the ultrasound components of a biophysical profile and no NST is part of that service. The record should support the clinical reason, the fetal observations and fluid assessment, and the interpreting clinician’s findings. CMS recognizes professional and technical portions: report modifier 26 for interpretation, modifier TC for equipment and staff, or no component modifier when billing the global service.
CMS billing rules for 76819
- 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 RVU0.75 · 29%
- Practice expense (office) RVU1.82 · 69%
- Malpractice RVU0.06 · 2%
6.6K
Medicare services in 2024 · #1699 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.
76819 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$114.27
76816 is a follow-up obstetric ultrasound focused on fetal growth or anatomy. It is not the four-part ultrasound assessment used for a biophysical profile.
$46.21
76820 evaluates umbilical artery blood flow with Doppler. It is a vascular assessment, not the ultrasound components of a biophysical profile.
Compare 76819 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
Rhode Island →
Office / nonfacility
$90.11
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 76819 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
8,799
- Code
- 76819
- Physician work
- 0.75
- Practice expense
- 1.82
- Malpractice
- 0.06
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.75 | × 1.019 | 0.7642 |
| Practice expense | 1.82 | × 1.033 | 1.8801 |
| Malpractice | 0.06 | × 0.892 | 0.0535 |
| Total RVUs | 2.6978 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$90.11
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1.019 |
| Practice expense | 1.82 | 1.033 |
| Malpractice | 0.06 | 0.892 |
(0.75 × 1.019 + 1.82 × 1.033 + 0.06 × 0.892) × $33.4009 = $90.11
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.
76819 billing questions
When should 76819 be chosen over 76818?
Use 76819 for the ultrasound components of a biophysical profile without an NST. Use 76818 when the service also includes the NST.
Which portions can be billed separately?
The professional interpretation may be reported with modifier 26, and the technical service with modifier TC. Billing without either modifier represents the global service.
What documentation supports 76819?
Document the reason for surveillance, findings for fetal breathing, movement, tone, and amniotic fluid, and the interpreting clinician’s conclusion. The service should not include an NST.
Is the NST included in 76819?
No. This code represents the ultrasound profile without an NST; 76818 represents a profile that includes one.
Can a fetal Doppler study be reported with 76819?
A separately performed and documented Doppler assessment, such as umbilical artery flow evaluation, may be reported when it is also clinically indicated.
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.
8,79676818,,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
8,80076819,26,Fetal biophys profil w/o nst,A,,0.75,0.31,,0.31,,0.04,1.10,1.10,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8,80176819,TC,Fetal biophys profil w/o nst,A,,0.00,1.51,,1.51,NA,0.02,1.53,1.53,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,3.16,3.16,0.04
8,80276820,,Umbilical artery echo,A,,0.49,0.83,,0.83,NA,0.03,1.35,1.35,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,3.36,3.36,0.07
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537