CPT 76145Radiology

Med physic dos eval rad exps

CPT 76145 covers the work of a medical physicist who calculates and verifies the exact radiation dose a patient receives during radiation therapy or diagnostic imaging procedures involving radiation exposure.

Showing rates for

National Average

Base Medicare rate

$955.52

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

PE RVU (NF)

29.03

MP RVU

0.51

Total RVU

29.54

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

NCCI bundling edits

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Billing tips

Document the specific radiation exposure event, calculation methodology, and physicist credentials in detail
Impact: Reduces denial risk by 60-70%; medical necessity must be clear and physicist qualifications must be verifiable
Bill only once per radiation exposure episode or treatment planning event, not per fraction or daily treatment
Impact: Prevents overbilling flags; most payers limit to one evaluation per treatment plan or significant exposure event
Maintain separation between 76145 (dose evaluation) and routine treatment planning physics services which may be included in treatment delivery codes
Impact: Prevents bundling denials; 76145 is for special dose evaluations beyond routine treatment planning
Verify medical physicist credentials are current and on file with payer before billing
Impact: Credential issues cause 30-40% of initial denials; proactive verification prevents payment delays
For commercial payers, obtain pre-authorization when dose evaluation is requested for non-standard reasons or research purposes
Impact: Increases approval rate from 60% to 95% for non-routine evaluations; prevents retrospective denials
Link to specific ICD-10 codes documenting radiation exposure concern, cancer diagnosis, or quality assurance indication
Impact: Strengthens medical necessity; improves first-pass payment rate by 25-35%

Common denials

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Frequently asked questions

What is CPT code 76145 used for?

CPT 76145 is used to bill for medical physics dose evaluation services where a qualified medical physicist calculates and documents radiation exposure doses for patient safety, regulatory compliance, or treatment quality assurance purposes. This is separate from routine treatment planning and represents a distinct professional evaluation.

How much does Medicare pay for CPT 76145 in 2025?

Medicare pays $955.52 for CPT 76145 in 2025 under the national average physician fee schedule rate. Both facility and non-facility rates are identical at $955.52, with a total RVU of 29.54.

Who can bill CPT code 76145?

Only qualified medical physicists certified by the American Board of Radiology (ABR) in Medical Physics, American Board of Medical Physics (ABMP), or equivalent certification can perform and bill for CPT 76145 services. Services must be performed by or under direct supervision of certified physicists, and state licensure requirements must be met where applicable.

Is CPT 76145 bundled with radiation therapy treatment planning codes?

CPT 76145 is not automatically bundled but should only be billed for dose evaluations that are separate and distinct from routine treatment planning physics services. It is appropriate for special dose calculations, exposure event investigations, quality assurance evaluations, or regulatory-required dose reconstructions beyond standard treatment planning.

How often can CPT 76145 be billed for the same patient?

CPT 76145 should be billed once per distinct radiation exposure event or treatment planning episode requiring special dose evaluation. It should not be billed per treatment fraction or daily. Multiple billings require clear documentation of separate medical necessity for each evaluation, such as different treatment sites or new exposure events.

What modifiers are commonly used with CPT 76145?

Modifiers 59 or XU are most commonly used with 76145 to indicate distinct procedural services when multiple dose evaluations are performed on the same date. Modifiers 76 and 77 may be used for repeat procedures by the same or different physicist when medically necessary. Modifiers 26 and TC are rarely applicable as this is primarily a professional service code.

What documentation is required to bill CPT 76145?

Required documentation includes the medical physicist's signed report with credentials, detailed description of the radiation exposure or treatment scenario, calculation methodology, specific dose values with units, clinical indication for the evaluation, comparison to relevant standards, and recommendations. Physicist certification credentials (ABR/ABMP) must be verifiable and on file.