CPT 76819, in plain terms, covers An ultrasound exam checking the baby's health and movement during pregnancy without a separate heart rate monitoring test. CPT 76819 is referenced in 5 tracked payer policy changes from Arkansas Medicaid, Maryland Medicaid, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 76819 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 76819 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.
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 considers in-office and in-hospital antepartum fetal surveillance with non-stress tests, contraction stress tests, biophysical profiles, modified biophysical profiles, and umbilical artery and middle cerebral artery Doppler velocimetry medically necessary when the criteria in this policy are met. For most pregnancies at increased risk of stillbirth due to utero-placental insufficiency, testing is considered appropriate beginning at 32 to 34 weeks of gestation, and testing is medically necessary beginning at 26 weeks for pregnancies with multiple or particularly worrisome high-risk conditions. Repeat testing is medically necessary until delivery while the condition that prompted testing persists, and remote non-stress testing, uterine artery Doppler for risk assessment or screening, and all other indications not listed as medically necessary are considered experimental, investigational or unproven.
Aetna reviewed its Clinical Policy Bulletin 0047 on prenatal care provided by primary care physicians on October 6, 2026, but the text provided does not say what changed. The policy still sets the conditions under which a family physician can provide only prenatal care to an Aetna member, including coordination with a participating obstetrician, Healthy Chapters enrollment and specific referral timing.
Watch 76819
Get one email when a payer policy names 76819, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
See every payer rule for 76819
Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 76819 in one place.
Get alerts for changes like this
Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.