CPT 76080Radiology

X-ray exam of fistula

CPT code 76080 covers an X-ray examination used to visualize a fistula, which is an abnormal connection between two body parts or between an internal organ and the skin. This specialized imaging helps doctors see the path and extent of the fistula tract.

Showing rates for

National Average

Base Medicare rate

$58.22

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.54

PE RVU (NF)

1.21

MP RVU

0.05

Total RVU

1.8

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document the exact anatomical location and type of fistula (perianal, enterocutaneous, rectovaginal, etc.) as this impacts medical necessity justification
Impact: Prevents $58.22 denial for lack of specificity; reduces audit risk by 60-70%
Bill the complete procedure code 76080 rather than attempting to bill fluoroscopy (76000) separately, as fluoroscopy is included in the fistulography procedure
Impact: Avoids unbundling denials and potential compliance issues; maintains full reimbursement
Ensure contrast material administration is documented in the procedure note, including type, volume, and injection technique
Impact: Critical for medical necessity determination; lack of contrast documentation results in 80% denial rate
Link to appropriate ICD-10 codes specifying fistula location (K60.3-K60.5 for anorectal, K63.2 for intestinal, N82.x for female genital)
Impact: Improves first-pass payment rate by 40%; prevents medical necessity denials
When performed in facility setting, verify whether to bill globally or with modifier 26, as both facility and non-facility rates are identical at $58.22
Impact: Ensures proper payment split between technical and professional components in split billing scenarios
Do not bill 76080 for sinus tract evaluations that are better classified under other codes; fistulography specifically requires demonstration of communication between two epithelialized surfaces
Impact: Prevents downcoding or denial; ensures correct code selection and payment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76080 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 76080 is $58.22 for both facility and non-facility settings. This is based on 1.8 total RVUs (0.54 work RVU, 1.21 PE RVU, 0.05 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 76080 and a regular X-ray?

CPT 76080 is a specialized fistulography exam that requires contrast material injection into a fistulous tract to visualize the abnormal connection, while regular X-rays (such as 7xxxx series codes) are standard radiographic imaging without contrast injection into the fistula. The fistulography procedure is more complex and allows surgeons to map the exact pathway before treatment.

Can CPT 76080 be billed with an E/M visit on the same day?

Yes, but the E/M service must be separately identifiable and significant beyond the usual pre-procedure assessment. Use modifier 25 on the E/M code if a separately identifiable evaluation led to the decision to perform the fistulography, and ensure documentation clearly separates the E/M service from the imaging procedure.

What documentation is required to bill CPT 76080?

Required documentation includes the written physician order, clinical indication with fistula location, contrast material type and volume, injection technique description, number of radiographic views, complete radiologist interpretation report describing the fistula tract pathway, and appropriate diagnosis codes specifying the fistula location and etiology.

How many RVUs is CPT code 76080 worth?

CPT code 76080 has a total of 1.8 RVUs in 2025, consisting of 0.54 work RVUs, 1.21 practice expense RVUs, and 0.05 malpractice RVUs. Both facility and non-facility PE RVU values are identical at 1.21.

What are common denial reasons for CPT 76080 claims?

The most common denials include lack of documented medical necessity, missing documentation of contrast material use, bundling with other same-day procedures, and incorrect code selection when the procedure was actually a sinus tract study rather than true fistulography. Each requires specific documentation elements in the appeal.

Which medical specialties typically bill CPT code 76080?

CPT 76080 is primarily billed by radiologists who perform and interpret the study, but may also be billed by colorectal surgeons, general surgeons, and gastroenterologists when performed in their facilities. Diagnostic imaging centers and hospital outpatient departments are the most common settings for this procedure.