CPT 76802, in plain terms, covers Ultrasound to check an additional baby during pregnancy before 14 weeks of gestation. CPT 76802 is referenced in 7 tracked payer policy changes from Arkansas Medicaid, Connecticut Medicaid (HUSKY Health), and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 76802 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 76802 on AAPC
Effective September 1, 2026, Arkansas Department of Human Services removed prior authorization limitations for non-stress tests (CPT 59025) and fetal ultrasounds (CPT 76801-76828). Providers can now bill these procedures without hitting the previous two-per-nine-month-period cap, but must maintain documentation supporting medical necessity for all claims, which remain subject to retrospective review and recoupment.
Connecticut Medicaid (HUSKY Health) increased reimbursement rates for obstetric surgical, radiology, and office services under OBS and FTO rate types to 120% of 2025 Medicare physician fee schedule, effective retroactively to January 1, 2026. Claims meeting the increased rates will be automatically adjusted on April 24, 2026.
Effective July 1, 2025, Maryland Medicaid now reimburses Certified Nurse Practitioners (CRNPs) for interpretation of specific radiological and imaging services. Billing teams must update systems to recognize CRNPs as eligible providers for 13 allowable CPT codes across chest X-rays, abdominal X-rays, obstetric ultrasounds, and radiotherapy planning. This applies to both fee-for-service and HealthChoice managed care organizations in Maryland.
Maryland Medicaid now allows certified nurse practitioners to interpret and bill for specific radiological and imaging services including chest X-rays, abdominal X-rays, obstetric ultrasounds, and other imaging studies. This expands billing opportunities for practices with CRNPs providing these interpretation services.
Aetna's Clinical Policy Bulletin 0530 covers transvaginal ultrasonography (CPT 76817 and 76830) when selection criteria are met. Covered indications include assessment of fetal viability and gestational age in the first trimester, assessment of pelvic masses, abnormal uterine bleeding, monitoring of follicular development during infertility therapy, ectopic pregnancy, vasa previa, suspected endometriosis, and post-menopausal bleeding. The policy considers TVUS experimental, investigational or unproven for screening for endometrial, ovarian or other gynecologic cancers and for preoperative prediction of lymph node metastasis in cervical cancer.
Aetna's Clinical Policy Bulletin 0530 covers transvaginal ultrasonography (TVUS), and its policy history shows a last review date of 08/20/2026. Aetna considers TVUS medically necessary for indications including assessment of fetal viability and gestational age in the first trimester when viability is uncertain, assessment of a pelvic mass, evaluation of abnormal uterine bleeding, diagnosis of ectopic pregnancy, evaluation of pelvic pain of suspected gynecologic origin, evaluation of infertility, guidance during embryo transfer, and verifying IUD position when the string is not visible. Aetna considers TVUS experimental, investigational or unproven for screening for endometrial cancer, ovarian cancer or other gynecologic cancers, and for preoperative prediction of lymph node metastasis in cervical cancer. Pelvic ultrasound is considered clinically integral to the transvaginal examination and does not warrant separate reimbursement.
Detailed fetal anatomic ultrasound (CPT 76811) is medically necessary for listed indications, including known or suspected fetal anatomic or genetic abnormalities, pregnancies resulting from in vitro fertilization (IVF), obesity with a pre-pregnancy body mass index of 30 kg/m2 or more, known or suspected Zika virus exposure, and a previous pregnancy with a fetus that had an omphalocele or other ultrasound detectable congenital anomaly associated with an elevated risk of recurrence. Ultrasounds done solely to determine fetal sex or to give parents a view and photograph of the fetus are not medically necessary, and more than one detailed fetal anatomic ultrasound in the first trimester or more than one in the second semester is considered not medically necessary. A limited duplex scan (CPT 93976) is medically necessary for listed obstetric indications such as vaginal bleeding in the second or third trimester, suspected placenta accreta spectrum, and suspected placental abruption, while a complete duplex scan (CPT 93975) during pregnancy is considered experimental, investigational, or unproven, and 3D and 4D fetal ultrasounds are not supported because of a lack of evidence that they alter management over standard two-dimensional ultrasound.
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