Breast Ultrasound CPT Codes | Descriptions & Billing Guide

The breast ultrasound CPT codes are CPT 76641 and CPT 76642. A comprehensive breast examination, including all four breast quadrants, can be reported with CPT code 76641. If your mammogram contains only one or two elements in CPT 76641, use the 76642 CPT code instead.

CPT code 76641 can be used for unilateral comprehensive breast ultrasound with real-time imaging documentation of the axilla. Breast Imaging Advantages Over Mammography for patients with dense breast tissue, digital mammography is an effective screening tool. 

Breast Imaging and Mammography for patients with dense breast tissue, digital mammography will become effective for medical procedures.

CPT code 76642 denotes a breast ultrasound examination that evaluates only a subset of the characteristics listed in CPT code 76641. If ultrasound imaging of the axilla performs, it will also include.

However, radiology services and clinics are rarely concerned about this. G0279 is an ancillary code that cannot report separately from CPT 77061 and CPT 77062.

If your insurance company does not cover mammograms for routine screening, you cannot write the more specific mammography CPT 77061 and CPT 77062.

Accurately reporting screening and diagnostic studies performed on the same service date could lead to complications. While new procedure codes establish for this innovation, not all payers will independently cover the costs. 

Still, the test’s diagnostic accuracy for early detection of breast cancer is unknown. Scintimammography will not effectively diagnose or screen breast cancer, so medical professionals do not recommend it.

Patients with dense breast tissue undergoing routine breast cancer screening do not require an ultrasound.

There is currently no clinical evidence that routinely incorporating ultrasonography into mammography screening reduces breast cancer mortality.

However, radiologists use breast ultrasound to locate lesions and guide the placement of tools for percutaneous breast biopsies and cyst aspirations, making it a dependable and medically necessary tool.

Using CAD to assist radiologists to detect breast cancer during the ultrasound is experimental and medically unnecessary. Adding CAD to ultrasonography has not been shown to improve patient outcomes or decrease mortality from breast cancer. 

Breast Imaging on a Computer with Tactile Feedback Tactile computer-assisted breast imaging provides no medical benefit or scientific rationale.

There is insufficient clinical evidence to say whether tactile breast imaging improves breast cancer screening or diagnosis outcomes. Better-designed studies, such as comparative, prospective, and randomized controlled trials, should be included in future research into this technology.

Breast ultrasound and mammography, regardless of age, should be used to examine any palpable breast masses. Ultrasound is helpful in biopsies. In two quantities, classify two-way communication as the 76641 CPT code or the 76642 CPT code. 

Women with clinically suspect lymph nodes can learn if they have positive nodes by performing a preoperative axillary ultrasound in conjunction with an FNA or biopsy. However, breast MRI has a higher sensitivity for detecting newly discovered malignancies than mammography and ultrasound.

Description Of The Breast Ultrasound CPT Codes

The official description of the CPT codes for breast ultrasound (CPT 76641 and CPT 76642) can be found in the CPT manual and can be found below.

CPT 76641: The official definition of the 76641 CPT code, as described by CPT’s manual, is: “Ultrasound, breast, unilateral, real-time with image documentation, including axilla when performed; complete.”

CPT 76642: The official definition of the 76642 CPT code, as described by CPT’s manual, is: “Ultrasound, breast, unilateral, real-time with image documentation, including axilla when performed; limited.”

CPT code 76641 describes a comprehensive breast examination that includes the retromolar area and all four breast quadrants. The provider should document a thorough examination of the affected area(s) with images and a final, written report of results, impressions, and so on to back up the service provided and billed.

Each breast ultrasound CPT code can only report once per session as CPT 76641 or CPT 76442. Regulations do not communicate with one another. If a medical condition necessitates imaging on both sides of the body, use Modifier 50 for a bilateral approach.

It is valid for the bilateral indicators CPT code 76641 and CPT 76442. If the breast ultrasound performs as an outpatient procedure, the hospital may itemize the technical portion of the service and charge it to the patient.

Outpatient hospital services are reimbursed based on the APC grouping associated with the CPT code submitted by the hospital. Medicare requires the same CPT code to be offered by the doctor’s office and the hospital’s outpatient clinic.

Once a mammographic lesion identifies, a breast ultrasound should use to evaluate it further (CPT 76641: unilateral, complete or CPT 76642: unilateral, limited). 

Ultrasound can perform on a smaller console or a handheld device. Both breast ultrasound CPT codes should report the payor’s assessment of the necessary care that must document in the patient’s medical chart; diagnostic ultrasounds and procedures performed under ultrasound guidance should register separately in the patient’s chart. 

Imaging data from diagnostic ultrasound procedures must collect and archive. All relevant information should provide, such as the ultrasound’s purpose, the structures or organs examined, and the results. Ultrasound images obtained as part of a patient’s care, digital or printed, should be archived securely.

Billing Guidelines

If performed, both breast ultrasound CPT code 76641 and 76442 involve an axillary exam. Despite the rarity of ultrasound services in such settings, Medicare will cover them as part of the MS-DRG payment system. However, the medical professional may choose to bill you for their time.

When reporting diagnostic digital breast tomosynthesis to Medicare, HCPCS code G0279, unilateral or bilateral, should be used (list separately in addition to G0204 or G0206). Differentiating a procedure or service from other non-E/M services performed on the same day may be necessary.

Modifier 59 can use to identify non-E/M processes and services that are relevant in the given context but could not typically report together.

Documentation for a breast ultrasound CPT code procedure will require sessions, surgeries, sites, organ systems, incisions, excisions, lesions, injuries (or areas of damage in extensive injuries), and other procedures performed on the same day by the same person.

When reporting a screening mammogram, both the CPT 77057 “Bilateral screening digital breast tomosynthesis” code and CPT 77063 “(Bilateral) screening mammography, bilateral (2-view film study of each breast)” code must report.

G0202 Screening mammography can produce a direct digital image, bilateral, all views when billing Medicare. When writing about 77055, 77056, 76376, and CPT 76377, please leave out the number 77063. It is a three-dimensional image. (Mammography).

How To Use Modifiers With The Breast Ultrasound CPT Codes

If a sentinel node biopsy for breast cancer staging reveals that cancer has spread, the patient will need to have additional lymph nodes removed.

A tracer material is injected during a melanoma lumpectomy with a sentinel node biopsy to identify the sentinel nodes. The sentinel nodes must remove for further investigation. Additional lymph node removal is unlikely if the sentinel lymph nodes are cancer-free.

Lymphadenectomy is not the same as a sentinel node biopsy. Confusion between the two can lead to incorrect medical billing claims.

When billing for the professional portion of the service, a physician who interprets ultrasound in an outpatient hospital can add modifier 26 to the breast ultrasound CPT code. 

Unless otherwise specified in the listings, modifier 50 can be used to bill for bilateral breast ultrasound CPT code procedures performed in the same operative session.

Payments for services with a bilateral payment indicator can increase to 150% of the unilateral amount to properly adjust cost when bilateral procedures should provide under the PFS. 

Suppose the breast ultrasound CPT code procedure is performed by the doctor who owns the ultrasound machine or by the sonographer performing the ultrasound. In that case, the global code could report without the 26 modifier in an office setting.

When billing for the service, the TC modifier would be used solely by the equipment owner to register the technical component.

Even though ultrasound services should rarely provide in an inpatient hospital setting, Medicare reimburses them using the Medicare Multiple Procedure Diagnostic Related Groups (MS-DRG) payment system. Even so, the doctor may still bill you for their services.

Reimbursement

Report ultrasound CPT code 76942 (Ultrasonic Guidance for Needle Biopsy) claim form alongside the 76645 CPT code (Ultrasound, Breast(s), unilateral or bilateral), B-scan, and or real-time with image documentation) claim form. In that case, it is eligible for separate breast ultrasound CPT code reimbursement.

Medicare may reimburse breast ultrasound CPT code procedures if deemed medically necessary and fall within the scope of the provider’s license.

Private health insurance policies differ significantly in terms of whether they will cover ultrasound procedures performed by a general practitioner or a radiologist.

Plans may also request that doctor’s offices submit requests to begin offering diagnostic ultrasound and ultrasound-guided procedures. It is critical to contact the payer ahead of time to determine what is required to submit a claim.

Because CMS does not recognize standalone diagnostic DBT codes, providers can only bill Medicare for diagnostic DBT in conjunction with a full-field digital mammogram ( CPT 77061 and CPT 77062).

Breast and melanoma cancers must screen using a surgical procedure known as a Coding Sentinel Node Biopsy (SNLB), which examines the lymphatic system to determine whether the disease has spread from the primary tumor.

Example 1

Entire ultrasound of the left and right breasts (e.g., all four quadrants examined in both breasts). File 76642-50. Medicare payers will reimburse at 150 percent of the fee schedule value for breast ultrasound CPT code 76642.

Example 2

Complete left breast ultrasound examination and examinations of the right breast’s two quadrants by ultrasound. Reports breast ultrasound CPT code 76641-RT and breast ultrasound CPT code 76642-LT 

• left breast exam in its entirety
• limited exam of the right breast

Example 3

Left breast and left axilla ultrasound examinations of all four quadrants are necessary. Therefore, we are applying for standard compensation. Report breast ultrasound CPT code 76641.