CPT 76816
Global XXX ActiveOb us follow-up per fetus
CPT 76816 Billing & Documentation Guide
CPT code 76816 (Ob us follow-up per fetus) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.83, a non-facility practice expense RVU of 2.45, and a malpractice RVU of 0.05, a total non-facility RVU of 3.33 and facility RVU of 3.33. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $115.12, though rates vary from $98.88 to $149.67 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 76816, 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 76816 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 2 units of 76816 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 76816
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.83 | 0.83 |
| Practice Expense RVU | 2.45 | 2.45 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 3.33 | 3.33 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 76816
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 | $126.45 | $126.45 | $118.78 - $149.67 | 29 |
| Florida | $113.08 | $113.08 | $108.46 - $117.13 | 3 |
| Georgia | $107.83 | $107.83 | $102.71 - $112.95 | 2 |
| Illinois | $110.08 | $110.08 | $105.05 - $114.92 | 4 |
| Michigan | $106.91 | $106.91 | $104.32 - $109.51 | 2 |
| North Carolina | $105.14 | $105.14 | $105.14 - $105.14 | 1 |
| New York | $122.6 | $122.6 | $106.64 - $129.9 | 5 |
| Ohio | $104.12 | $104.12 | $104.12 - $104.12 | 1 |
| Pennsylvania | $109.91 | $109.91 | $104.42 - $115.4 | 2 |
| Texas | $109.99 | $109.99 | $103.74 - $115.84 | 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 76816
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 76816 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 76805 | Column 1 (primary), can be billed with modifier | 9 | Mutually exclusive procedures |
| 76810 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 76815 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 76856 | Column 1 (primary), can be billed with modifier | 9 | Mutually exclusive procedures |
Frequently Asked Questions, CPT 76816
What does CPT code 76816 mean? +
CPT code 76816 represents: Ob us follow-up per fetus. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 76816? +
The 2026 Medicare national average non-facility payment for CPT 76816 is $115.12. Rates range from $98.88 to $149.67 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 76816? +
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 76816? +
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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