CPT 76380Radiology

Cat scan follow-up study

CPT code 76380 covers follow-up CT scans performed after an initial imaging study to monitor changes, evaluate treatment response, or track disease progression. This is a limited study focused on a specific area or question, not a complete new scan.

Showing rates for

National Average

Base Medicare rate

$128.74

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

0.98

PE RVU (NF)

2.94

MP RVU

0.06

Total RVU

3.98

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

NCCI bundling edits

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Billing tips

Clearly document that 76380 represents a limited follow-up study, not a complete diagnostic CT scan, to justify using this lower-valued code versus complete CT codes
Impact: Prevents upcoding accusations and ensures correct code selection; complete CT codes reimburse significantly higher but require full diagnostic protocols
Include comparison with prior imaging dates and findings in the radiology report to demonstrate the follow-up nature of the study
Impact: Strengthens medical necessity documentation and reduces denial risk by 40-50% for follow-up imaging claims
Verify that the ordering physician's documentation specifies a limited follow-up study rather than a comprehensive evaluation to support code selection
Impact: Alignment between order and report justifies 76380 selection and prevents payer downcoding or denials
Use modifier 26 or TC appropriately when splitting professional and technical components between providers to capture full available reimbursement
Impact: Ensures both facility and reading radiologist receive appropriate payment portions of the $128.74 total
Bill 76380 only once per anatomic region per session; multiple follow-up areas may require additional codes or complete CT codes depending on extent
Impact: Prevents unbundling denials while ensuring appropriate payment for actual work performed
Maintain prior imaging comparison studies for at least 7 years to support audit requests demonstrating the limited follow-up nature of 76380 studies
Impact: Protects against recoupment during audits; lack of comparison documentation can result in 100% denial and repayment demands

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76380 in 2025?

The 2025 Medicare national average reimbursement for CPT 76380 is $128.74 for both facility and non-facility settings. This rate is based on 3.98 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 76380 and a complete CT scan code?

CPT 76380 is a limited follow-up CT study focused on monitoring a previously identified finding or answering a specific question, while complete CT codes (such as 71250-71270 for chest, 74150-74178 for abdomen) represent comprehensive diagnostic imaging of an entire anatomic region. The follow-up study uses fewer imaging sequences, has a more focused interpretation, and reimburses significantly less than complete diagnostic CT examinations.

How many RVUs is CPT code 76380 worth in 2025?

CPT 76380 has a total of 3.98 RVUs in 2025, consisting of 0.98 work RVUs, 2.94 practice expense RVUs (both facility and non-facility), and 0.06 malpractice RVUs. This relatively low RVU value reflects the limited nature of follow-up imaging compared to comprehensive CT studies.

Can CPT 76380 be billed with other CT codes on the same day?

Billing 76380 with other CT codes on the same day is generally not appropriate unless the studies involve completely different anatomic regions or represent distinctly separate clinical sessions. When legitimately separate, modifier 59 should be appended to indicate distinct procedural services. Most payers will bundle multiple CT studies of the same or overlapping areas performed on the same date.

What documentation is required to bill CPT 76380?

Documentation must clearly identify the study as a limited follow-up examination, reference the specific prior imaging being compared (with date), state the clinical indication for follow-up, describe the limited imaging protocol used, provide comparison findings, and include the radiologist's interpretation and signature. The ordering physician's documentation should also support medical necessity for follow-up imaging at the specified timeframe.

How often can CPT 76380 be billed for the same patient?

There is no Medicare-specified frequency limitation for 76380, but medical necessity must be documented for each follow-up study. Frequency should align with evidence-based guidelines for the condition being monitored. Unusually frequent follow-up imaging may trigger payer review or denials, requiring strong clinical justification such as rapidly changing findings or treatment response monitoring.

Who can bill CPT code 76380?

CPT 76380 can be billed by board-certified or board-eligible radiologists and other physicians qualified to interpret CT imaging who perform and document the professional interpretation. The technical component can be billed by hospitals, imaging centers, and other facilities that provide the equipment, technologist, and supplies. The professional and technical components may be split between different providers using modifiers 26 and TC.