CPT 76801: OB ultrasound, 1st trimester, single
What this code means, what it should cost, and how to dispute an overcharge.
Fair Price Reference
What is CPT 76801?
CPT 76801 (OB ultrasound, 1st trimester, single) is a ob/gyn billing code defined by the American Medical Association. It's used to bill your insurance or you directly for this service.
What CPT 76801 should cost
The Centers for Medicare & Medicaid Services (CMS) pays approximately $109 for CPT 76801 under the 2025 Physician Fee Schedule. This is what the federal government has determined is a reasonable payment for this service.
Private insurance typically pays 1.2–1.8x Medicare rates ($131–$196). Hospital chargemaster prices for CPT 76801 often range from $200 to $1000 — a markup of 1.8x to 9.2x over Medicare.
Common overcharges on CPT 76801
Billing prenatal office visits separately on top of the global delivery code. Facility fees for delivery billed in addition to the global code when the facility is the billing entity.
About OB/GYN billing
OB/GYN delivery codes are 'global' — they include prenatal care, delivery, and postpartum care. Separate billing for included services is improper unbundling.
Request the itemized bill. Prenatal visits billed separately from the global delivery code (59400/59510) are improper.
How to dispute a CPT 76801 overcharge
- Request the itemized bill. You are entitled to a detailed line-by-line bill showing every CPT code billed. Ask in writing.
- Compare to Medicare allowable. If the charge exceeds 150% of Medicare ($164), you have grounds to dispute.
- Request documentation. For E&M codes, ask for the visit note. For procedures, ask for the operative report. The documentation must justify the code billed.
- Send a formal dispute letter. Cite the specific discrepancy between the documentation and the code. Reference Medicare rates and NCCI edits where applicable.
- Follow up in writing. Give the provider 30 days to respond. If they don't, escalate to the state attorney general and insurance commissioner.
Got CPT 76801 on your bill?
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