Introduction: Why Diagnostic Imaging Billing Matters in OBGYN
Ultrasound and diagnostic imaging are essential tools in obstetrics and gynecology. From confirming pregnancies to evaluating uterine abnormalities, these services offer vital insights that guide clinical decision-making. But providing excellent care is only half the job—getting reimbursed properly is the other half. In Maryland, where both Medicaid and a wide range of private payers operate, understanding the billing process for OBGYN imaging is critical for practice sustainability.
Many providers miss revenue opportunities or face denials simply because they’re unfamiliar with the correct use of CPT and ICD-10 codes, payer-specific rules, and billing documentation requirements. This article breaks it all down for you—step by step.
Types of Ultrasound and Diagnostic Imaging in OBGYN
1. Obstetric Ultrasound
- Confirmation of pregnancy
- Dating scan
- Anatomy scan
- Biophysical profile (BPP)
- Fetal growth monitoring
2. Gynecological Ultrasound
- Transvaginal ultrasound
- Follicular tracking
- Assessment of abnormal bleeding or pelvic pain
- IUD placement verification
3. Other Diagnostic Imaging
- Sonohysterography
- Hysterosalpingography (HSG)
- Pelvic MRI (rare but billable)
Common CPT Codes for OBGYN Ultrasound Services
Obstetric Ultrasound CPT Codes
- 76801 – Complete OB ultrasound, first trimester
- 76802 – Subsequent fetus, first trimester
- 76805 – Complete OB ultrasound, second or third trimester
- 76811 – Detailed fetal anatomic exam
- 76815 – Limited OB ultrasound (fetal heartbeat, position, or amniotic fluid)
- 76816 – Follow-up OB ultrasound
- 76818 – Fetal biophysical profile
Gynecological Imaging CPT Codes
- 76830 – Transvaginal ultrasound, non-obstetric
- 76831 – Saline infusion sonohysterography
- 76856 – Pelvic ultrasound, non-obstetric, complete
- 76857 – Pelvic ultrasound, non-obstetric, limited or follow-up
- 74740 – Hysterosalpingography, radiological supervision and interpretation
Modifiers Often Used in Imaging Billing
- -TC – Technical component (when imaging is done in-house without interpretation)
- -26 – Professional component (interpretation only)
- -76 – Repeat the procedure by the same provider
- -59 – Distinct procedural service (when billing multiple imaging services)
🔍 Tip: Make sure your billing software or clearinghouse separates global, technical, and professional services properly when submitting imaging claims.
ICD-10 Codes That Justify Imaging Procedures
Common OB-Related ICD-10 Codes
- Z32.01 – Pregnancy confirmed
- O09.90 – Supervision of high-risk pregnancy, unspecified
- Z34.91 – Encounter for supervision of normal pregnancy
Common GYN-Related ICD-10 Codes
- N92.5 – Frequent menstruation
- N80.0 – Endometriosis of the uterus
- R87.619 – Abnormal Pap smear
- N93.9 – Abnormal uterine and vaginal bleeding, unspecified
- Z30.430 – Encounter for insertion of IUD
Proper ICD-10 coding is critical to establishing medical necessity for the imaging performed.
Medicaid Imaging Billing Rules in Maryland
1. Prior Authorization May Be Required
Some advanced procedures (e.g., HSG or pelvic MRI) may need prior approval from the patient’s Medicaid MCO.
2. Global Billing vs. Split Billing
Practices must specify if they are billing globally (both technical and professional components) or separately. Misuse of modifiers like -TC or -26 can lead to denials or overpayments.
3. Frequency Limits
Maryland Medicaid restricts the number of ultrasounds allowed during pregnancy unless medically indicated. Providers must document the reason for multiple scans.
4. Point-of-Care vs. Diagnostic Imaging
Brief point-of-care ultrasounds (e.g., checking fetal heartbeat) are often bundled into E/M services and not billable as separate imaging unless thoroughly documented.
Commercial Payer Considerations
Each private insurance company has its own policies about:
- Frequency of scans
- Medical necessity criteria
- Modifiers and bundling rules
- Global vs. split billing practices
- Network participation in imaging services
Always check each payer’s imaging policy and fee schedule before submitting.
Best Practices for Imaging Documentation
- Include Clear Indications – What prompted the scan? Symptoms? Follow-up?
- Attach Full Reports – Document findings, interpretation, and comparison to prior scans.
- Use Templates – Create structured ultrasound documentation forms to ensure consistency.
- Code the Right Laterality – Especially for pelvic exams, make sure side-specific issues are clearly noted.
- Sign Off by Physician – Ultrasounds must be read and signed by a qualified provider for full reimbursement.
Avoiding Common Imaging Billing Errors
- Billing global services when only technical or professional components were provided
- Failing to use modifiers -TC or -26 appropriately
- Using incorrect or non-specific ICD-10 codes
- Submitting multiple scans on the same day without distinct documentation
- Forgetting to link ultrasound CPT codes to appropriate Z or O-series diagnosis codes
How Global Tech Billing LLC Supports Imaging Billing in Maryland
At Global Tech Billing LLC, we work with OBGYN providers to ensure imaging services are billed with precision and confidence. Our services include:
- CPT and ICD-10 code validation
- Modifier and component billing guidance
- Medicaid MCO prior authorization management
- Denial tracking and appeals for imaging claims
- Routine audits of ultrasound billing documentation
Discover our medical billing services in Maryland and ensure every scan gets paid appropriately.
Conclusion
Ultrasound and diagnostic imaging are central to women’s health, yet billing for them in Maryland OBGYN practices can be complicated. From selecting the right CPT and ICD-10 codes to applying the right modifiers and understanding payer-specific rules, the margin for error is narrow—but avoidable.
By staying informed, documenting thoroughly, and partnering with experts like Global Tech Billing LLC, your practice can reduce denials, optimize revenue, and focus on delivering quality patient care.
FAQs
1. Can I bill for a transvaginal and pelvic ultrasound on the same day?
Yes, but you’ll need proper documentation and may require modifier -59.
2. Is prior authorization needed for OB ultrasounds in Maryland?
Not for routine ones, but advanced imaging may require approval depending on the payer.
3. What’s the difference between 76801 and 76805?
76801 is for first-trimester ultrasound; 76805 is for the second or third trimester.
4. Do I always need to use modifier -26 or -TC?
Yes, when you’re not billing globally. Use -26 for professional only, -TC for technical only.
5. Why was my ultrasound claim denied?
Common reasons include lack of medical necessity, incorrect ICD-10, or missing modifiers.
Meta Title: Billing for Ultrasound & Imaging in Maryland OBGYN Clinics
Meta Description: Learn how to bill for ultrasound and diagnostic imaging in Maryland OBGYN practices. Includes CPT codes, ICD-10 links, and Medicaid billing tips.