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  • Obstetrical Ultrasound Certification Request Form

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OBSTETRICAL ULTRASOUND CERTIFICATION REQUEST FORM FAX: 800.540.2406 Please be advised that all questions must be answered completely. Failure to do so may delay a determination. Patient name: DOB:.

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CPT® 76817, Under Diagnostic Ultrasound Procedures of the Pelvis Obstetrical. The Current Procedural Terminology (CPT®) code 76817 as maintained by American Medical Association, is a medical procedural code under the range - Diagnostic Ultrasound Procedures of the Pelvis Obstetrical.

76815 Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., Fetal heartbeat, placental location, fetal position and/or qualitative amniotic fluid volume,1 or more fetuses.

Code 76816 describes and examination designed to reassess fetal size and interval growth or reevaluate one or more anatomic abnormalities of a fetus previously demonstrated on ultrasound, and should be coded once for each fetus requiring reevaluation using modifier 50 for each fetus after the first.

The current complete OB ultrasound codes include: 76801, 76802, 76805, 76810, 76811, 76812, and 76817.

CPT code 76816 will be reimbursed when reported with modifier 59 for each additional fetus. CPT codes 76818 and 76819: Profile assessments will be reimbursed for the second and any additional fetuses and should be reported separately by code 76818 or 76819 with the modifier 59 appended.

One standard second or third trimester ultrasound (76805) is allowed per pregnancy. Subsequent standard second or third trimester ultrasounds are considered not medically necessary as a limited or follow-up ultrasound assessment (76815 or 76816) should be sufficient to provide a re-examination of suspected concerns.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232