Ultrasound Pelvis price: Medicare anchor and facility lever
Anchor for Ultrasound Pelvis - CPT 76856
$103.52
Professional (26) $33.01 plus technical (TC) $70.51.
Hospital OPPS facility anchor, this code billed alone: $106.81 (APC 5522, Level 2 Imaging without Contrast; national unadjusted, before wage-index adjustment).
Composite APC 8004: $300.57 (multi-study only, national unadjusted).
A complete pelvic ultrasound through the abdomen is CPT 76856, and it is frequently ordered together with the transvaginal study, 76830. When both are done at one visit the bill carries two codes. A quote that names only one of them is not the price of the visit.
CPT code
76856
Ultrasound, pelvic (nonobstetrical), real time with image documentation; complete
CPT 76856 is a complete pelvic ultrasound. A limited or follow-up study is 76857, and a transvaginal study is 76830. The order should name which study is expected.
The codes this visit can be billed under
| CPT | PFS office or global | PFS facility (professional) | Global period | Hospital single-service APC | Minimum Medicare copay at hospital |
|---|---|---|---|---|---|
| 76856 (this page) | $103.52 | $103.52 | not a surgical global | $106.81 (APC 5522) | $21.37 |
| 76830 | $115.68 | $115.68 | not a surgical global | $106.81 (APC 5522) | $21.37 |
Billed alone in a hospital, 76856 maps to CY2026 APC 5522 at $106.81, with a minimum unadjusted copayment of $21.37. CMS Addendum B lists 76856 with status indicator Q3 and the transvaginal study 76830 with status indicator S, both at APC 5522, so a visit with both studies is expected to produce two facility lines; ask the hospital whether any composite payment applies to its claim rather than assuming one.
In an imaging center the two global anchors are $103.52 and $115.68. Ask whether the center's cash price for the pair is a single bundled figure or the sum of two code prices.
A written quote for a two-study pelvic visit is complete only if it shows four amounts in a hospital setting, two facility lines and two reading fees, or two global amounts in an office. Ask for each line by code.
Inside and outside the 76856 anchor
Covered by the anchor
- Sonographer time and image acquisition
- Interpreting physician interpretation and written report
- Standard image storage
Billed outside it
- A transvaginal study billed under a separate code when performed
- The ordering visit and follow-up visit
- Repeat or limited follow-up scans billed separately
Why prices vary for CPT 76856
Pelvic ultrasound has no contrast or radiation overhead, so the global anchor is modest. A hospital still bills the OPPS ultrasound composite for the facility portion when composite rules are met, while an office or imaging center bills the global amount. Where the study is performed changes who bills the facility portion.
Ask whether the study can be done in the physician office or imaging center rather than the hospital outpatient department, and confirm the cash price for the complete study (76856).
Questions specific to Pelvic ultrasound
- Will the visit include only 76856, or also a transvaginal study (76830)?
- If both are done, is the quoted price for both codes?
- Is the location a hospital department or an imaging office?
- If both pelvic studies are done, is the reading physician's fee quoted once or twice?
Ultrasound Pelvis: billing questions
Why did my pelvic ultrasound bill two codes?
A complete pelvic study through the abdomen (76856) and a transvaginal study (76830) are separate codes. When both are done at one visit, both can be billed. Ask in advance whether both are expected.
Is the hospital amount the same for both pelvic ultrasound codes?
In CY2026 both map to single-service APC 5522 when billed alone. Composite rules can change how a hospital is paid when several ultrasound services are on one claim.
Is a limited pelvic study a different code?
Yes. A limited or follow-up pelvic study uses 76857, with its own anchor. Match the code on the order before you compare quotes.
What is the reading fee for a complete pelvic ultrasound?
The CY2026 Michigan Locality 01 professional component for 76856 is $33.01, out of a $103.52 global anchor. In a hospital that reading fee usually arrives on a separate bill from the facility charge.