Have you ever considered having sound waves bounced off your baby to create an image that we can use to measure a small pocket of liquid near the neck that might signal chromosome abnormalities? Yeah, the thought never crossed my mind either. I probably don’t even know how to change a diaper.
Fortunately, we get to benefit from all those before us who studied this kind of thing. In many ways, their work has made it the standard of care we enjoy today.
It’s easy to lose sight of this and let service delays and out-of-pocket costs overshadow how advanced our healthcare system is. That might even be something worth reflecting on the next time your exam is running 10 minutes late. Are you still feeling a little “inconvenienced”?
Don’t get me wrong; I still enjoy doing these “how much should it cost” write-ups. But that’s mostly because it helps me better understand the clinical side of the services I spend so much time analyzing the finances on.
So let’s get to it. What is a nuchal translucency ultrasound and how much should it cost?
Mrs. Max OOP is Ordered a Nuchal Translucency Ultrasound
If you have been following along at home, you might know that Mrs. Max OOP is expecting on or around 4/23/2021. She had her first ultrasound back in September 2020 while she was up in Canada. As it turns out, several ultrasounds are required throughout the pregnancy process.
I guess I always assumed it would just be a one-and-done type of thing.
So up next for us was a screening ultrasound that measures nuchal translucency. On the street, you might hear this called a “nuchal scan”. But what the heck is a nuchal translucency ultrasound and how much should it cost?
Frankly, after learning about this screening, I do not really care how much it costs. We would have it done regardless. I am largely doing this write-up for my own personal benefit to make sure I understand the general clinical concepts behind the screening.
What is Nuchal Translucency?
Nuchal translucency (NT) is a collection of fluid under the skin at the back of a fetus’s neck. This fluid level is usually measured between eleven and thirteen weeks into pregnancy. The fact that we have this narrowed down to a three-week window makes this screening even more impressive. At this point in the pregnancy, the fetus is about the size of a lime. Apparently, the short window to do this test is because, after 13 weeks, the tissue gets so thick it is no longer translucent.
Depending on where you look on the internet, a nuchal translucency less than 3.5mm is considered normal when the fetus measures between 45mm and 84mm. However, it can be difficult to define a fixed abnormal measurement because the nuchal translucency increases as the fetus grows. This website suggests an NT of up to 2mm is normal at about 11 weeks, and up to 2.8 mm by 13 weeks.
Evidently, as these fluid levels increase, so does the risk of Down’s syndrome. This test helps provide a probability of the fetus having chromosomal abnormalities. A nuchal translucency of more than 6mm has a high probability of Down’s syndrome and other chromosome abnormalities. That said, the NT scan results on their own have an accuracy rate of about 70-75%. It is important to remember the nuchal translucency is a basic screening test that is best combined with other lab tests. In other words, it is just one piece of a complex equation that can be used to increase the accuracy rate.
This random study from the internet published in 2015 evaluated over 1,600 pregnant women. The average NT thickness was 1.3 (+ -) 0.54 mm.1 Increased NT thickness > 2 mm was only found in 89 of the women (5.5%). It is worth noting these were pregnant Iranian women. Mrs. Max OOP is not Iranian, so my reference to this study is likely already suspect. The study does specifically say the reference range in their study was different than that reported in other ethnic groups.
Internet Calculators for Nuchal Translucency
I did find this internet calculator that can help compare a specific NT to the averages. It references a few studies from the 90s. Retirement calculators are more of my thing, but I went ahead and dropped in our numbers.
This calculator said our NT was in the 48th percentile which is right where we want to be.
It also accurately predicted our gestational age at the time of this ultrasound to the day (13 weeks, 5 days).
I am not a clinician and have absolutely no expertise in this field of study. Random calculators and studies from the internet are not good enough for me. Having some background certainly doesn’t hurt, but I tend to defer to the experts and review these numbers with the doctors we hire who actually know what they are talking about.
Back in October, our doctor up in Canada said our test came back normal. Even better, when compared with some other labs drawn around the same time, things looked great. We were happy. But even that’s not a guarantee.
What Code Represents the Nuchal Translucency Ultrasound?
In healthcare, we track everything with a code. This service is no different.
The CPT code 76813 represents the ultrasound where the fetal nuchal translucency is measured in the first trimester. For this ultrasound, we can use 76813 universally regardless of whether the exam is transabdominal or transvaginal.
The measurement is taken from the image of the maximum thickness of the zone between the inside of the fetal skin and the outer side of the soft tissue that overlies the cervical spine or occipital bone. As I mentioned above, an increased nuchal translucency thickness in the first trimester is associated with chromosomal and genetic abnormalities. This can include Down’s syndrome, trisomy 13 or 18, and heart abnormalities.
Remember there are two parts to this service. There is a facility/technical fee that represents the specialized ultrasound equipment, space, supplies, and trained technician performing the actual ultrasound.
Then there is the professional fee. This fee is for a radiologist to write a written report of his or her interpretation of the image.
Some clinics and imaging centers will combine these together into a global charge.
How Much Should the Nuchal Translucency Ultrasound Cost?
But with a blog called Max Out of Pocket, we have to at least peek at cost, right?
In my limited experience, it seems that this ultrasound is often farmed out to an imaging center that specializes in this type of thing. I believe specialized, highly sensitive ultrasound equipment is also required. I am sure some hospitals do it, but that does not seem to be the norm particularly in the rural areas I spend a lot of my time in. So, I will not bother going too deep into hospital pricing for this particular test. Feel free to chime in in the comments if I am oversimplifying anything here.
But we should look, at least, at one hospital price. I will go ahead and pick on the University of Michigan again today. Their hospital charges $659 for just the ultrasound. That wouldn’t include the professional read.
I would typically recommend having this type of thing done in the clinic or imaging center setting. There, this test would generally come in between $200-$475. The 50th percentile, according to the Medicare standard analytical file, would have the test at $330. That said, Medicare statistics might not be the best place to look for pricing on this test because not a lot of Medicare-aged patients have this done.
How Much Would We Have Paid in the United States?
If Mrs. Max OOP was in New England, we would have had this service at an imaging center because our local hospital does not offer it. The imaging center would have charged us about $295 for the nuchal ultrasound. Unfortunately, we would have needed to drive about an hour and a half to get it.
According to the clinic, about $170 of that represents the facility/technical component and the remaining $125 is for the professional radiologist to read the images.
My $22,450 insurance plan would get us a discounted price of about $170 out the door. This covers both the professional fee and the facility fee for providing the equipment, tech, supplies, and space to perform the service. Since we did not have any healthcare services up until that point in 2020, this entire $170 would have been applied to our family deductible. In other words, it would have come right out of our pocket.
How Much Did We Pay in Canada?
Since Mrs. Max OOP was hanging out in Canada for several months, she had this service north of the border. Even though she is a citizen, she was still considered an uninsured cash patient because her insurance did not turn back on right away.
With no car, she also walked about 40 minutes to her appointment; what a trooper!
She paid $207 Canadian for this service. The exchange rate at the time puts it at $154 USD. That is another $16.00 in savings by not using our insurance and paying cash in Canada.
The infrastructure our medical industry has in place continues to impress me. Countless services are out there just waiting for us to need them. People like me might not even know they exist until there is a need for it.
The fact that humans know this nuchal translucency measurement association exists is amazing on its own.
It is obviously not perfect, and I saw a few studies out there that seemed to question the detection rates. But at the end of the day, we will go with the recommendation of our doctor since they are the experts. We will never turn a blind eye to the cost, though.
In the United States, this exam really should cost less than $300 in the appropriate setting, which is generally not a hospital. We paid $154 (USD) in Canada.
- Sharifzadeh M, Adibi A, Kazemi K, Hovsepian S. Normal reference range of fetal nuchal translucency thickness in pregnant women in the first trimester, one center study. J Res Med Sci. 2015 Oct;20(10):969-73. doi: 10.4103/1735-1995.172786. PMID: 26929762; PMCID: PMC4746871.