76942, cpt 76942, 76942 cpt code, cpt code 76942

(2023) CPT Code 76942 | Description, Guidelines, Reimbursement, Modifiers & Example

CPT code 76942 describes the ultrasound guidance for major or minor surgical procedures like breast nodule biopsies, aspiration, and localizing device placement. With the help of ultrasound guidance, the provider can introduce the needle inside the body to reach the specific tissue or target site. In addition, it helps in performing tissue biopsy or aspiration. The exclusive practice of this method provides the surgeon the flexibility to execute the surgical procedure without damaging any nearby tissues or organs.

CPT Code 76942 | Description & Explanation

CPT code 76942 is ultrasonic supervision and guides needle placement required for procedures such as injections, breast biopsies, placing localizing devices, or needle aspirations. 

The official description of CPT 76942 is: “Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation.”

76942 CPT Code Description
76942 CPT Code Description

The sound waves pass through different tissue densities and reflect a receiving unit at varying speeds. The unit converts the waves to electrical pulses immediately displayed in picture form on the screen.

The ideal route is evaluated, from the surface to the marked tissue, as soon as the precise access site for the needle is sited, accompanied by the deepness of the target tissue. Then the needle is inserted and advanced to the lesion under ultrasonic supervision.

Sound waves of higher frequencies are used by Ultrasonography (above the standard hearing capacity of a healthy human, i.e., 20,000 Hz or 20 kHz) to visualize the body’s internal organs. 

Sound waves are reflected at different speeds by the different types of tissues, e.g., bones, muscles, etc. when a sound wave passes through the human body.

These rebounding waves are captured by the detector and converted into images. While carrying out the surgical procedure, such as a needle biopsy, the provider needs diagnostic guidance to identify the exact location to be biopsied to place the needle in that region accurately.

With the help of the Ultrasound guidance (76942 CPT Code) technique, the provider can perform the major or minor surgical procedures specific to the targeted anatomic region of the human body. In addition, several different invasive procedures are accomplished with the help of ultrasound direction.

Note: CPT code 76942 reports the imaging supervision and interpretation only for the specific procedure.

CPT 76942 belongs to the IR (interventional Radiology) procedure category. Interventional Radiology is when a provider performs ultrasound or fluoroscopic procedures to get images of the inside of the body. IR (Interventional Radiology) procedure (CPT 76942) permits two crucial things simultaneously. 

The first one is that the surgeon gets direct access to the part of the body that needs some interventions to get treated or diagnosed. 

At the same time, the second one prevents any injury to the adjacent tissues from the risky tissue.

Billing Guidelines

CPT code 76942 is mainly used for percutaneous procedures. Percutaneous surgeries are on the same day, and minimally invasive surgical procedures have 0 day global period. The 76942 CPT code is used as a diagnostic ultrasound for non-vascular procedures.

That means if a surgeon wants to access any bone joints or muscular structure for any intervention, he may get the help of ultrasound imaging to prevent adjacent tissue damage.

As per the guidelines, MUE (medically unlikely edits) adjudication indicator for CPT 76942 is represented as three dates of service (DOS) and 1 unit is allowed to bill for one provider on the same date of service (DOS) under a single NPI (National Provider Identifier). But for several units of CPT code 76942, more than one can be billed, depending on diverse circumstances.

CPT code 76942 was introduced on 1st January 1993 and updated on 1st January 2001.

Note: Ultrasound guidance CPT 76942 has zero global periods.

During coding or billing, one should remember that the fundamental difference between ultrasound guidance studies is comprehending the selection of accurate CPT and appropriate reimbursements. CPT 76942 and CPT 76937 are both used for ultrasound guidance. But the 76942 CPT code is used as ultrasound guidance for non-vascular access, and CPT 76937 is used as ultrasound guidance for vascular access.

In interventional radiology (IR), if ultrasound supervision is carried out for the vascular procedure, the coder or biller may use CPT 76937. Some of the common examples are central venous catheter placement and angioplasty. While coding the CPT 76942, a few main normalities should be followed in the documentation: the blood vessel potency, image recording, and ultrasound guidance documentation. 

The examples for CPT code 76942, ultrasound guidance non-vascular procedures, are arthrogram, arthrocentesis, biopsy, etc., where the target site is not a vessel.

Do not report CPT 76942 with the following codes:

CPT 10004, CPT 10005, CPT 10006, CPT 10021, CPT 10030, CPT 19083, CPT 19285, CPT 20604, CPT 20606, CPT 20611, CPT 27096, CPT 32408, CPT 32554, CPT 32555, CPT 32556, CPT 32557, CPT 37760, CPT 37761, CPT 43232, CPT 43237, CPT 43242, CPT 45341, CPT 45342, CPT 46948, CPT 55874, CPT 64415, CPT 64416, CPT 64417, CPT 64445, CPT 64446, CPT 64447, CPT 64448, CPT 64479, CPT 64480, CPT 64483, CPT 64484, CPT 64490, CPT 64491, CPT 64493, CPT 64494, CPT 64495, CPT 76975, CPT 0213T, CPT 0214T, CPT 0215T, CPT 0216T, CPT 0217T, CPT 0218T, CPT 0232T, CPT 0481T, CPT 0582T


The billing guidelines and reimbursement policy for CPT code 76942 are governed by the appropriate usage of Modifiers, Place of services (POS), and medical necessity as per the stated local coverage determination (LCD).

Both government (Medicaid or Medicare) and commercial payers have similar rules and policies for this procedure (CPT 76942). Therefore, the health provider’s office must adequately document the ultrasound guidance procedure (CPT 76942) and the primary procedure that may act as the principal service in the claim.

If any payer does not cover the 76942 CPT code, ABN (Advance Beneficiary Notice) must be presented to the patient before providing the service. If the payer (insurance company) denies the service at a later stage, it can be billed and reimbursed by the patient.

Ultrasound guidance procedure (CPT 76942) should be billed as the second line item in a claim at the secondary position. The primary CPT code in the claim must always be the surgery procedure code followed by the US guidance CPT code 76942. 

Mainly with the major procedures, the 76942 CPT code is considered a bundled service, such as breast biopsy and spinal injection procedure.

CPT code 76942 is used only once in the same encounter, even if two or more lesions are needle biopsied simultaneously. The provider must confirm individual payer policies against several units allowed per service date (DOS) for commercial insurance. 

Most commercial payers allowed only one-time usage of this CPT in an encounter. Therefore, do not use laterality or anatomical modifiers like LT, RT, and 50 with CPT 76942. Laterality modifiers are not eligible with CPT code 76942.

Note: 76942 needs a separate report (not part of the primary procedure notes) to fulfill the radiology documentation requirements. Sometimes, payers make it obligatory to submit complete documentation for the procedure.

While coding IR (interventional radiology) procedures, selecting the correct code is essential because reimbursement is highly dependent on code selection. The service fee (FFS) comparison between CPT 76942 and CPT 76937 is about $19.

CPT 76937: The Fee for Service (FFS) for the facility and non-facility is $40.49.

CPT 76942: The Fee for Service (FFS) for the facility and non-facility is $59.52.

Adding Modifiers To A CPT 76942 Claim

Modifiers with CPT code 76942 can only be used if a procedure has been reformed, changed, or renewed by some definite conditions but has not been altered in its concrete description.

While claim submission, the appropriate placement of a modifier plays a key role. As per CMS rule, the pricing modifier should be placed first, followed by the statistical or payment eligible modifier, and in the last laterality modifier. 

Laterality modifiers, such as LT, RT, and 50, are also called anatomical modifiers. Laterality or anatomical modifiers are invalid and are not required to be billed with CPT 76942.

CPT code 76942 includes professional and technical components in its RVU (Relative Value Unit) package. 

The technical component of the 76942 CPT code is the performance of the test by the technician.

While the professional component of CPT code 76942 is interpreting the test and preparing a detailed report.

Both parts of this procedure can be represented and billed separately. If a hospital or provider must bill this for a technician, it is billed under technician NPI (National Provider identifier) with modifier TC.

If a provider delivers only professional services and must bill this for a physician, then it is billed under physician NPI (National Provider Identifier) with modifier 26.

Neither modifier TC nor modifier 26 are required for billing these services globally. The coder or biller can bill this procedure (CPT 76942) without modifiers, and the benefits of both components (technical and professional) may be included in the single line item.

The provider may not submit CPT code 76942 globally to commercial or private payers when ultrasound guidance on the 76942 CPT code is performed as an add-on service with any other principal procedure in Hospital outpatient or ASC (Ambulatory surgery center) settings because the hospital may bill for the technical component of the procedure. 

CPT 76942 may be billed with a professional component (modifier 26) for the radiologist In the above setting. 

For trigger point injections, when two different sites are approached on the same date of service (DOS), e.g., the trapezius muscle and the gluteus muscle, are injected for pain management on the same day, then it may be billed with the CPT code 76942 twice.

Because the access sites are in different body regions. In such circumstances, the coder or biller must use eligible payment modifiers to notify the insurance that the service was necessary to perform repeatedly. 

The coder may use the modifier XS to present that the service was performed on a different structure for Medicare. While for commercial insurance, one may use the modifier 59 for the same purpose.

Although, per CMS-released guidelines and data, no CCI conflict is even billed twice in separate line items.

On the other hand, if the trigger point is in the same region, like the trapezius and posterior cervical, only one unit may be billed because the site of the body or structure on which the procedure is performed is the same.

In the surgical post-operative Global period, one may have to use modifier 79 to notify the payers that service is not performed as a part of previous services to the same patient. It has a global period of 10 days in case of minor surgery and 90 days in major surgery.

Billing Example For CPT Code 76942

A 65-year-old patient came to the provider in an outpatient hospital setting with a lab report of an elevated PSA, hematuria, and urinary incontinence (prostate-specific antigen) with a value greater than 4.0 ng/ml. 

After a physical examination, the physician decided to do a prostate biopsy with ultrasound guidance to rule out malignancy. A patient already has a high PSA level and prostate enlargement.


CPT Codes:

  • CPT 99213: Office or other outpatient visit for the evaluation and management of an established patient: This code is used for the initial outpatient visit where the patient came with lab reports and discussed the elevated PSA, hematuria, and urinary incontinence.
  • CPT 55700: Biopsy, prostate; needle or punch, single or multiple: This code is used to document the prostate biopsy procedure performed by the physician.
  • CPT 76942: Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision, and interpretation: This code is used to document the use of ultrasound guidance during the prostate biopsy procedure.

ICD-10 Codes:

  • ICD 10 R80.71: Hematuria, symptomatic: This code documents the patient’s hematuria.
  • ICD 10 R32: Unspecified urinary incontinence: This code documents the patient’s urinary incontinence.
  • ICD 10 R97.20: Elevated prostate-specific antigen [PSA]: This code documents the patient’s elevated PSA level.
  • ICD 10 N40.1: Enlarged prostate with lower urinary tract symptoms: This code documents the patient’s prostate enlargement and associated urinary symptoms.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *