CPT Code 76880 — through Dec 31st, 2010

Diagnostic Ultrasound, extremity, non-vascular, B-scan and/or real time imaging with image documentation. Average Medicare reimbursement: $94 (non-Medicare reimbursement as high as $120 or more). This is the code you would use if you were looking at the plantar fascia, at neuromas, at tendons, etc.

 

CPT Code 76882 — starting Jan 1st, 2011

Ultrasound, extremity, nonvascular, real-time with image documentation, limited, anatomic specific. CPT Guidelines: A limited, anatomic-specific ultrasound examination is performed primarily for evaluation of muscles, tendons, joints, and/or soft tissues. It is a limited examination where a specific anatomic structure such as a tendon or muscle (or plantar fascia) is being assessed. The code would also be used to evaluate a soft-tissue mass that may be present in an extremity where knowledge of its cystic or solid characteristic is needed. The vast majority ultrasound examinations performed by foot and ankle specialists would be expected to fall in the CPT 76882 – limited, anatomic specific – category. Reimbursements should likely remain the same (or at least approximately the same) as for the original, more generic 76880.

CPT Code 76942

Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization of device), imaging supervision and interpretation. The average reimbursement for ultrasound-guided injections is $150 (non-Medicare reimbursement as high as $175). No replacements to this code have been announced that we know of.

 

Note: be sure to download our special billing report, covering the proper way to document your procedures.

 

Note regarding billing for bilateral studies …

Generally you want to avoid this, or at least limit how often you are submitting bilateral cases. In some states you will receive 100% payment on each scan; in others you will receive 100% on the first scan, 50% on the second. But if you do too many of these, you’re apt to throw up a red flag.

If you do bill for bilateral scans, you normally will not use a modifier, but simply bill them separately and designate one as Left (LT) and one as Right (RT). But check with the insurance carrier, because this can vary from state to state. One of our clients in Florida, for instance, wrote regarding this approach: “We use the RT and LT modifier without a problem … For Medicare, we use the ‘T’ codes for right 2, 3, etc) and for Blue Shield and United, if we’re doing two ultrasounds on the same foot, we use the ’76’ modifier.”