CPT 76512Radiology

Oph us dx b-scan

CPT code 76512 covers an ophthalmic ultrasound B-scan, a diagnostic imaging test that uses sound waves to create a two-dimensional image of the inside of the eye when direct visualization is difficult or impossible.

Showing rates for

National Average

Base Medicare rate

$46.26

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

0.56

PE RVU (NF)

0.85

MP RVU

0.02

Total RVU

1.43

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

NCCI bundling edits

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Billing tips

Always append laterality modifiers (RT, LT, or 50) as many payers require them for ophthalmic procedures
Impact: Prevents automatic denials and delays; some payers reject claims without laterality modifiers
Document the specific clinical indication requiring B-scan (e.g., dense cataract preventing fundus visualization, vitreous hemorrhage) in the medical record
Impact: Essential for medical necessity; lack of clear indication is the #1 denial reason for this code
Bill 76512 only once per eye per session regardless of the number of images taken during that examination
Impact: Prevents unbundling denials; multiple images are included in the single code
For bilateral scans, verify payer-specific policy on modifier 50 vs. billing twice with RT/LT modifiers
Impact: Modifier 50 typically reimburses at 150% ($69.39) vs. two separate line items; payer policies vary
Ensure the interpreting physician personally documents the interpretation and findings in the medical record, not just the technician's report
Impact: Required for compliance; audits frequently target lack of physician documentation, risking recoupment of $46.26 per claim
When performed on the same day as an E/M service, ensure the B-scan is separately identifiable and documented as a distinct service
Impact: Prevents bundling into the E/M code; clear separation supports payment of both services

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76512 in 2025?

The 2025 Medicare national average reimbursement rate for CPT code 76512 is $46.26 for both facility and non-facility settings, based on 1.43 total RVUs and a conversion factor of 32.3465.

Can I bill CPT 76512 for both eyes on the same day?

Yes, when B-scans are performed on both eyes during the same session, bill with modifier 50 (bilateral) or submit two line items with RT and LT modifiers, depending on payer preference. Bilateral billing typically reimburses at 150% of the single eye rate.

What is the difference between CPT 76512 and 76513?

CPT 76512 is a diagnostic B-scan performed for initial evaluation, while 76513 represents an anterior segment ultrasound biomicroscopy (UBM). These are distinct procedures with different equipment, techniques, and clinical applications.

Do I need a specific diagnosis code to bill CPT 76512?

Yes, you need a diagnosis code documenting medical necessity, such as dense cataract (H26.x), vitreous hemorrhage (H43.1x), corneal opacity (H17.x), or suspected retinal detachment (H33.x). The diagnosis must justify why direct visualization was inadequate.

How many RVUs is CPT code 76512 worth?

CPT 76512 has 1.43 total RVUs for 2025, comprised of 0.56 work RVUs, 0.85 practice expense RVUs (both facility and non-facility), and 0.02 malpractice RVUs.

Can CPT 76512 be billed with an office visit on the same day?

Yes, CPT 76512 can be billed with an E/M service on the same day if both are medically necessary and separately documented. The B-scan should be clearly indicated based on findings from the office visit examination. No modifier is typically required as 76512 is not bundled into E/M codes.

What documentation is required for Medicare to pay CPT 76512?

Medicare requires documentation of the medical necessity (reason direct examination was inadequate), laterality, physician interpretation of the B-scan findings with images, correlation with clinical symptoms, and any pathology identified. The interpreting physician must personally sign and date the interpretation.