Multi‐Society Guideline for Coding, Billing, and Clinician Training for Detailed Fetal Anatomy Ultrasound in the First Trimester

It is crucial to emphasize the significance of reimbursing Detailed First‐Trimester Ultrasounds (DFTUs) and the proposed adjustment to the guidance for CPT® code 76811, traditionally associated with second‐trimester ultrasounds. Historically, this code has been restricted to one examination per pregnancy, a limitation acknowledged by medical societies and underscored by payor policies. However, in light of evolving medical practices and the consensus among major imaging and women's health organizations, there is a compelling need to adapt this code for dual utilization during pregnancy. This change not only facilitates the provision of essential DFTUs but also contributes to reproductive health access in the current healthcare landscape.

Furthermore, recognizing the pivotal role of physicians in ensuring access to DFTUs is essential. Physicians play a crucial part in making these services available, and equitable access can only be achieved through proper reimbursement. Adequate payment not only encourages healthcare professionals to enhance their skills but also motivates them to seek continuous education, ultimately raising the standard of care and expanding access for individuals seeking reproductive health services.

AIUM Document Update Details

76811—CPT® Code in category: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach, single or first gestation

Part 1: Coding and Billing (Endorsed by the American Institute of Ultrasound in Medicine [AIUM], Society for Maternal‐Fetal Medicine [SMFM], American College of Obstetricians and Gynecologists [ACOG], American College of Osteopathic Obstetricians and Gynecologists [ACOOG], Society of Diagnostic Medical Sonography [SDMS], Society of Radiologists in Ultrasound [SRU], Society of Family Planning [SFP], Fetal Heart Society [FHS])

The 76811 code for indicated Detailed Obstetrical Ultrasound is typically used at the end of the first trimester (DFTU) and again in the second/third trimester (DSTU) per pregnancy.

• Supported as separate examinations (performed at different times in the gestation).

• Supported as distinct examinations because each examination has a defined list of imaging criteria and an individual AIUM practice parameter:

  • AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days. J Ultrasound Med 2021; 40(5):E1–E16. doi: 10.1002/jum.15477. Epub 2020 Aug 27. PMID: 32852128.
  • AIUM Practice Parameter for the Performance of Detailed Second‐ and Third‐Trimester Diagnostic Obstetric Ultrasound Examinations. J Ultrasound Med 2019; 38(12):3093–3100. doi: 10.1002/jum.15163. PMID: 31736130.

• Billed as above per pregnancy and per facility.

• This document applies only to the DETAILED OB scan (CPT 76811), which is an indication‐driven examination for patients with a known risk factor, suspected anomaly, or other concern, including an abnormal standard diagnostic obstetrical ultrasound examination.

  • American College of Radiology. ACR–ACOG–AIUM–SMFM–SRU practice parameter for the performance of standard diagnostic obstetrical ultrasound. 2023; Available at: https://www.acr.org/‐/media/ACR/Files/Practice‐Parameters/US‐OB.pdf. Accessed September 19, 2023.

• Performance and interpretation require advanced imaging skills, knowledge, and the ability to effectively communicate findings.

• Not intended to be a routine examination performed for all pregnancies.

• Critical role of first‐trimester anatomic imaging in the current era of narrowing and limited reproductive choice options.

• Detailed anatomic scans of the fetus are optimally performed in facilities that are accredited by organizations such as the American College of Radiology (ACR) or the AIUM.

Part 2: Training and Maintenance of Competence (Endorsed by the AIUM, SMFM, ACOG, ACOOG, SDMS, SFP, FHS)

Recommended OB‐GYN physician sonologist and sonographer qualifications to perform/interpret the 76811 Detailed Obstetrical Ultrasound

• Initial training:

  • Completion of an accredited residency in obstetrics and gynecology and subspecialty training in maternal‐fetal medicine or obstetric ultrasound imaging of at least 1 year's duration that includes structured training in detailed fetal anatomic ultrasound under the supervision of a qualified physician(s) who has met the training standards. Structured training includes:

    • For the second‐/third‐trimester examination, the trainee must have been involved in the performance, interpretation, and reporting of a minimum of 100 detailed fetal anatomic ultrasound examinations in fetuses at increased risk for structural or genetic conditions. At least 25 of these 100 detailed fetal anatomic evaluations should be in fetuses with major morphologic abnormalities.
    • Additionally, if performing Detailed Fetal Anatomic and Placental Assessment between 12 weeks 0 days and 13 weeks 6 days, expanded experience is required with a minimum of 25 detailed first‐trimester fetal anatomic assessments, 5 of which must be in fetuses with a major structural anomaly.
• Maintenance of competence: OB‐GYN physician sonologists performing detailed fetal anatomic ultrasound examinations must demonstrate evidence of continuing competence in the interpretation and reporting of those examinations.

  • For second‐ and third‐trimester detailed obstetrical ultrasound, a minimum of 100 diagnostic detailed fetal anatomic ultrasound examinations per year, including the performance, interpretation, and/or review of 10 fetuses with major structural anomalies is recommended to maintain the physician's skills. The physician is expected to obtain 10 hours of AMA PRA Category 1 Credits™ dedicated to detailed fetal ultrasound every 3 years.
  • Additionally, for those performing Detailed Fetal Anatomic and Placental Assessment between 12 weeks 0 days and 13 weeks 6 days, a minimum of an additional 25 detailed first‐trimester fetal ultrasound examinations, including 5 fetuses with major structural anomalies per year, is recommended to maintain the physicians' skills. The physician is expected to obtain an additional 5 hours of AMA PRA Category 1 Credits™ dedicated to first‐trimester detailed fetal ultrasound every 3 years.

• Sonographers should be credentialed by the American Registry for Diagnostic Medical Sonography (ARDMS) or the American Registry of Radiologic Technologists (ARRT) in OB‐GYN ultrasound and, optimally, should attain the same experiential and continuing medical education (CME) requirements in detailed obstetrical ultrasound as the interpreting physician sonologist.

ACOG: Mark Turrentine, MD

ACOOG: Eric Carlson, DO

ACR: Lauren Nicola, MD

AIUM: Bryann Bromley; Mishella Perez, RDMS, RDCS

AIUM Staff: Therese Cooper, RDMS

FHS: Anita Moon‐Grady, MD

SDMS: John Trombly, MS, RDMS

SFP: Catherine D. Cansino, MD

SMFM: Brian Iriye, MD; Vanita Jain, MD; Anthony Sciscione, DO

SRU: Carol B. Benson, MD