CPT 76815
Global XXX ActiveOb us limited fetus(s)
CPT 76815 Billing & Documentation Guide
CPT code 76815 (Ob us limited fetus(s)) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.63, a non-facility practice expense RVU of 1.76, and a malpractice RVU of 0.05, a total non-facility RVU of 2.44 and facility RVU of 2.44. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $84.25, though rates vary from $72.4 to $109.02 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 76815, 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 76815 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 76815 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 76815
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.63 | 0.63 |
| Practice Expense RVU | 1.76 | 1.76 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 2.44 | 2.44 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 76815
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 | $92.26 | $92.26 | $86.72 - $109.02 | 29 |
| Florida | $83.27 | $83.27 | $79.75 - $86.46 | 3 |
| Georgia | $79.16 | $79.16 | $75.47 - $82.84 | 2 |
| Illinois | $81.11 | $81.11 | $77.32 - $84.52 | 4 |
| Michigan | $78.6 | $78.6 | $76.6 - $80.59 | 2 |
| North Carolina | $76.96 | $76.96 | $76.96 - $76.96 | 1 |
| New York | $89.89 | $89.89 | $78.06 - $95.39 | 5 |
| Ohio | $76.4 | $76.4 | $76.4 - $76.4 | 1 |
| Pennsylvania | $80.6 | $80.6 | $76.59 - $84.61 | 2 |
| Texas | $80.59 | $80.59 | $76.09 - $84.76 | 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 76815
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 76815 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 | No | 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 |
| 59025 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 76805 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 76827 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 76815
What does CPT code 76815 mean? +
CPT code 76815 represents: Ob us limited fetus(s). It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 76815? +
The 2026 Medicare national average non-facility payment for CPT 76815 is $84.25. Rates range from $72.4 to $109.02 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 76815? +
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 76815? +
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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