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76604

Ultrasound, chest, real-time with image documentation

Radiology Ultrasound 2.91 Total RVUs
Quick Reference
For ultrasound of chest

Relative Value Units (RVUs)

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Work RVU
0.55
Physician effort
PE RVU
2.30
Practice expense
MP RVU
0.06
Malpractice
Total RVU
2.91
Combined value
Dollar reimbursement rates vary by locality and payer. RVUs shown for relative comparison only.
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Clinical Information

When to Use

For ultrasound of chest

Time Requirement
15-25 minutes typical procedure time

Common Scenarios

Pleural effusion evaluation
Chest mass evaluation
Chest wall evaluation
Lung pathology evaluation
Diaphragm evaluation

Documentation Requirements

  • Indication for chest ultrasound
  • Findings and interpretation
  • Real-time imaging documented
  • Comparison to prior studies if available
  • Report documentation

Coding Guidelines

Common Modifiers

26 Professional component only (interpretation)
TC Technical component only (equipment/staff)
59 Distinct procedural service if performed separately

Bundling Rules

  • Includes ultrasound chest
  • Includes interpretation and report
  • Real-time imaging included
  • Chest X-ray coded separately
  • CT chest coded separately

Exclusions

  • 71020 (chest X-ray, 2 views)
  • 76536 (ultrasound, soft tissues of head and neck)
  • 76700 (ultrasound, abdominal, complete)
  • 76705 (ultrasound, abdominal, limited)

Coding Notes

No global period - diagnostic procedure
Real-time imaging with documentation
Professional and technical components may be separate
Document indication and findings

Clinical scenarios

Pleural effusion evaluation
Pleural effusion evaluation
When to use:For ultrasound of chest
  • Indication for chest ultrasound
  • Findings and interpretation
  • Real-time imaging documented
Chest mass evaluation
Chest mass evaluation
When to use:For ultrasound of chest
  • Indication for chest ultrasound
  • Findings and interpretation
  • Real-time imaging documented
Chest wall evaluation
Chest wall evaluation
When to use:For ultrasound of chest
  • Indication for chest ultrasound
  • Findings and interpretation
  • Real-time imaging documented

Who are you?

Code Details

Code 76604
Category Radiology
Subcategory Ultrasound
Total RVUs 2.91

Medicare Pricing

PFS
2025 National Rate
$56.28
Facility
$56.28
Non-Facility
$56.28
RVU Breakdown
Work RVU:0.59PE RVU:1.11MP RVU:0.04Total RVU:1.74CF:$32.3465Global Days:XXX
OPPS Details
APC:5522Status:Q1Copayment:
Physician Fee Schedule: Medicare pays physicians based on Relative Value Units (RVUs) multiplied by a conversion factor.

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Frequently Asked Questions

What is CPT code 76604?

CPT 76604 is the billing code for "Ultrasound, chest, real-time with image documentation". For ultrasound of chest

How much does Medicare pay for CPT 76604?

Medicare pays approximately $56.28 for CPT 76604 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

What are the RVUs for CPT 76604?

CPT 76604 has a total RVU of 2.91, broken down as: Work RVU 0.55, Practice Expense RVU 2.30, and Malpractice RVU 0.06. RVUs (Relative Value Units) determine Medicare reimbursement rates.

What documentation is required for CPT 76604?

Key documentation requirements for CPT 76604 include: Indication for chest ultrasound; Findings and interpretation; Real-time imaging documented; Comparison to prior studies if available. Missing or incomplete documentation is a leading cause of claim denials for this code.

Can CPT 76604 be billed with other codes?

Bundling considerations for CPT 76604: Includes ultrasound chest. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.

What modifiers are commonly used with CPT 76604?

Common modifiers for CPT 76604 include: 26 (Professional component only (interpretation)), TC (Technical component only (equipment/staff)), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

What is the time requirement for CPT 76604?

The typical time requirement for CPT 76604 is 15-25 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.

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