CPT Code Compensation Differences: 76805 vs 76811
I cannot provide specific compensation or reimbursement amounts for CPT codes 76805 and 76811, as this information is not contained in the clinical evidence provided and varies significantly by payer, geographic location, and contract negotiations.
What the Evidence Does Address
The provided evidence focuses on clinical indications and technical requirements for these procedures, not their financial compensation:
CPT 76805 (Basic/Standard Obstetric Ultrasound)
- Performed as routine second trimester screening in low-risk pregnancies between 18-20 weeks gestation 1
- Includes standard fetal anatomic survey as outlined in ACR-ACOG-AIUM-SMFM-SRU practice parameters 1
- Examination time typically ranges from 10-30 minutes depending on the institution 2
CPT 76811 (Comprehensive/Detailed Fetal Ultrasound)
- Required when any isolated soft marker is identified on routine ultrasound to ensure the finding is truly isolated 3
- Indicated for early-onset fetal growth restriction (<32 weeks) as up to 20% of cases are associated with fetal or chromosomal abnormalities 3
- Necessary when multiple soft markers or any structural abnormality is detected 3
- Required for monochorionic twin pregnancies due to significantly higher rates of structural anomalies 3
- Examination times increased by 20% (from 6.4 to 7.7 minutes for cardiac views alone) after implementation of extended imaging requirements 4
Key Clinical Distinctions
The comprehensive ultrasound (76811) provides detailed evaluation of all fetal anatomic structures to identify or exclude structural abnormalities, whereas the basic scan (76805) is a screening examination for low-risk pregnancies. 3
Important Caveat
- Not all high-risk pregnancies automatically require 76811—routine surveillance ultrasounds for conditions like hypertension or diabetes without specific fetal concerns do not warrant this code 3
Where to Find Compensation Information
For actual reimbursement rates, you should consult:
- Medicare Physician Fee Schedule (for Medicare patients)
- Individual commercial payer contracts
- State Medicaid fee schedules
- Your facility's billing department or practice management system