Who reviews prior authorization requests for Ultrasound scan focusing on a limited area of the abdomen (CPT 76705)?

Most commercial payers hand imaging reviews to a radiology benefit manager. For the payers tracked here, requests are reviewed using guidelines from eviCore, Carelon, CMS, UnitedHealthcare / eviCore. The request is submitted through that organization's portal rather than the health plan's general line.

What should be in the clinical notes before requesting Ultrasound scan focusing on a limited area of the abdomen (CPT 76705)?

Reviewers look for a recent office visit that documents the symptoms and how long they have lasted, exam findings, results of any earlier imaging, treatments already tried and how the patient responded, and the specific question the study is expected to answer. The diagnosis code on the request should match what the notes describe.

CPT 76705: Ultrasound scan focusing on a limited area of the abdomen - Prior Authorization and Price

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CPT 76705

Ultrasound scan focusing on a limited area of the abdomen.

Ultrasound

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	48 that name this code
Anthem BCBS	Carelon	Current guideline	None found
Cigna	eviCore	Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	48 that name this code
Medicare	CMS	—	None found
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare	UnitedHealthcare / eviCore	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	48 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss Ultrasound scan focusing on a limited area of the abdomen. Each has its own criteria for when the study is considered appropriate.

Cirrhosis and Liver Screening for Hepatocellular Carcinoma (HCC); Ascites and Portal Hypertension Aetna · Cigna · UnitedHealthcare
Pancreatitis Aetna · Cigna · UnitedHealthcare
Liver Lesion Characterization Aetna · Cigna · UnitedHealthcare
Abdominal Mass Aetna · Cigna · UnitedHealthcare
Abdominal Pain Aetna · Cigna · UnitedHealthcare
Spleen Aetna · Cigna · UnitedHealthcare
Transplant Aetna · Cigna · UnitedHealthcare
Abdominal Sepsis (Suspected Abdominal Abscess) Aetna · Cigna · UnitedHealthcare
Abnormal Liver Chemistries Aetna · Cigna · UnitedHealthcare
Hepatic and Abdominal Arteries Aetna · Cigna · UnitedHealthcare
Inflammatory Bowel Disease Aetna · Cigna · UnitedHealthcare
Generalized Abdominal Pain Aetna · Cigna · UnitedHealthcare
Hematopoietic Stem Cell Transplantation (HSCT) Aetna · Cigna · UnitedHealthcare
Intussusception Aetna · Cigna · UnitedHealthcare
Liver Disease Aetna · Cigna · UnitedHealthcare
Postoperative Pain within 60 Days Following Abdominal Surgery Aetna · Cigna · UnitedHealthcare
Right Lower Quadrant Pain Aetna · Cigna · UnitedHealthcare
Vomiting Infant, Malrotation, and Hypertrophic Pyloric Stenosis Aetna · Cigna · UnitedHealthcare
Cardiac Imaging in Transplants Aetna · Cigna · UnitedHealthcare
Disorders of the Aorta and Visceral Arteries Aetna · Cigna · UnitedHealthcare
Hematopoietic Stem Cell Transplantation Aetna · Cigna · UnitedHealthcare
Melanomas and Other Skin Cancers Aetna · Cigna · UnitedHealthcare
Pancreatic Cancer Aetna · Cigna · UnitedHealthcare
Patent Urachus Aetna · Cigna · UnitedHealthcare
Pediatric Lymphomas Aetna · Cigna · UnitedHealthcare
Pelvic Pain/Dyspareunia, Female Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare

Typical price

Commercial insurance, median

$344

Middle half of rates: $182 to $604

Medicare, hospital outpatient

$107

Facility payment

Medicare, physician fee schedule

$87

National, non-facility

Commercial figures come from negotiated rates published by 1,069 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for Ultrasound scan focusing on a limited area of the abdomen change.

CPT 76705: Ultrasound scan focusing on a limited area of the abdomen - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

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