$86.48
Use 76820 for umbilical artery Doppler findings and 76821 for middle cerebral artery Doppler findings. They identify different fetal vessels.
On this page
CMS RVU26D · Effective 2026-10-01
76820 Umbilical artery Doppler Medicare reimbursement rates in Wisconsin
Reports Doppler assessment of fetal umbilical artery blood flow, commonly used in high-risk pregnancy monitoring when placental circulation is a concern. Compare 76820 office and facility rates across CMS payment localities in Wisconsin.
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 76820 in Wisconsin?
Wisconsin 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
$43.23
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 76820: Fetal umbilical artery Doppler study
Reports Doppler assessment of fetal umbilical artery blood flow, commonly used in high-risk pregnancy monitoring when placental circulation is a concern.
This study uses ultrasound Doppler to assess blood-flow patterns in the fetal umbilical artery, providing information about circulation between the fetus and placenta. Maternal-fetal medicine specialists, obstetricians, or sonographers working under appropriate supervision may perform it in an office, imaging department, or hospital setting. It is commonly part of surveillance for a growth-restricted fetus or suspected placental insufficiency; it is distinct from a routine fetal anatomy or growth examination.
Report the service when the umbilical artery Doppler assessment is performed and documented, including the fetus assessed, the study findings, and the clinical indication. The record should support that this was a Doppler flow evaluation rather than only a general obstetric ultrasound. CMS recognizes professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies equipment and staff, and billing without either modifier represents the global service.
CMS billing rules for 76820
- 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 RVU0.49 · 36%
- Practice expense (office) RVU0.83 · 61%
- Malpractice RVU0.03 · 2%
3.3K
Medicare services in 2024 · #2107 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.
76820 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$106.63
76816 reports a follow-up obstetric ultrasound focused on fetal reassessment, such as growth. It does not identify the specific umbilical artery Doppler service.
$116.70
76818 reports a fetal biophysical profile performed with a nonstress test. Choose 76820 when the documented service is umbilical artery Doppler assessment.
Compare 76820 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
Wisconsin →
Office / nonfacility
$43.23
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 76820 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
8,802
- Code
- 76820
- Physician work
- 0.49
- Practice expense
- 0.83
- Malpractice
- 0.03
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.49 | × 1.000 | 0.4900 |
| Practice expense | 0.83 | × 0.958 | 0.7951 |
| Malpractice | 0.03 | × 0.308 | 0.0092 |
| Total RVUs | 1.2944 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$43.23
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.49 | 1 |
| Practice expense | 0.83 | 0.958 |
| Malpractice | 0.03 | 0.308 |
(0.49 × 1 + 0.83 × 0.958 + 0.03 × 0.308) × $33.4009 = $43.23
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.
76820 billing questions
How is this different from a middle cerebral artery Doppler?
This code is for Doppler assessment of the fetal umbilical artery. Use 76821 for the fetal middle cerebral artery; the vessel studied determines the code.
Can it be reported with a fetal growth ultrasound?
It may be reported with a separately performed growth assessment, such as 76816, when both the growth ultrasound and umbilical artery Doppler are documented as distinct services.
What do modifiers 26 and TC identify?
Modifier 26 identifies the professional interpretation, while modifier TC identifies the technical service, including equipment and staff. Without either modifier, the claim represents the global service.
What documentation supports reporting this code?
Document the clinical reason for the Doppler, which fetus and vessel were assessed, and the flow findings or interpretation. A general obstetric ultrasound without a documented umbilical artery Doppler assessment does not support this service.
Is this the same as a fetal biophysical profile?
No. This code reports umbilical artery blood-flow assessment; 76818 and 76819 report fetal biophysical profile services, with and without a nonstress test, respectively.
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.
8,79976819,,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
8,80376820,26,Umbilical artery echo,A,,0.49,0.21,,0.21,,0.02,0.72,0.72,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8,80476820,TC,Umbilical artery echo,A,,0.00,0.62,,0.62,NA,0.01,0.63,0.63,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,3.15,3.15,0.05
8,80576821,,Middle cerebral artery echo,A,,0.68,1.98,,1.98,NA,0.04,2.70,2.70,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,3.47,3.47,0.05
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,