CPT 76813
Global XXX ActiveOb us nuchal meas 1 gest
CPT 76813 Billing & Documentation Guide
CPT code 76813 (Ob us nuchal meas 1 gest) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.15, a non-facility practice expense RVU of 2.24, and a malpractice RVU of 0.07, a total non-facility RVU of 3.46 and facility RVU of 3.46. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $119.28, though rates vary from $103.88 to $151.78 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 76813, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 76813 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 76813 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 76813
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.15 | 1.15 |
| Practice Expense RVU | 2.24 | 2.24 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 3.46 | 3.46 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 76813
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $129.59 | $129.59 | $122.32 - $151.78 | 29 |
| Florida | $118.03 | $118.03 | $113.45 - $122.21 | 3 |
| Georgia | $112.65 | $112.65 | $107.94 - $117.35 | 2 |
| Illinois | $115.31 | $115.31 | $110.37 - $119.66 | 4 |
| Michigan | $111.96 | $111.96 | $109.36 - $114.55 | 2 |
| North Carolina | $109.71 | $109.71 | $109.71 - $109.71 | 1 |
| New York | $126.88 | $126.88 | $111.13 - $134.17 | 5 |
| Ohio | $109.08 | $109.08 | $109.08 - $109.08 | 1 |
| Pennsylvania | $114.54 | $114.54 | $109.3 - $119.78 | 2 |
| Texas | $114.45 | $114.45 | $108.67 - $119.72 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 76813
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 76813 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0567T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0689T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0690T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 51701 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 51702 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 76815 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 76830 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 76857 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
Frequently Asked Questions, CPT 76813
What does CPT code 76813 mean? +
CPT code 76813 represents: Ob us nuchal meas 1 gest. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 76813? +
The 2026 Medicare national average non-facility payment for CPT 76813 is $119.28. Rates range from $103.88 to $151.78 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 76813? +
Radiology codes rely heavily on the professional/technical split: modifier 26 (professional component only) and TC (technical component only). Also common: 50 (bilateral imaging), 76 (repeat by same physician), 77 (repeat by different physician), and LT/RT for laterality.
What bundling edits apply to CPT 76813? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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