CPT 76604Radiology

Us exam chest

CPT code 76604 covers an ultrasound examination of the chest, which uses sound waves to create images of structures in the chest wall, pleural space, and lungs. This non-invasive imaging test helps doctors evaluate fluid collections, masses, or abnormalities in the chest area.

Showing rates for

National Average

Base Medicare rate

$56.28

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

0.59

PE RVU (NF)

1.11

MP RVU

0.04

Total RVU

1.74

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

NCCI bundling edits

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Billing tips

Always verify that the examination does not include cardiac structures; if the heart is imaged, use echocardiography codes (93303-93352) instead of 76604
Impact: Prevents automatic denials and recoupment; cardiac imaging incorrectly billed as 76604 results in 100% denial
Document all required elements: indication, technique, findings for each anatomic area examined, and clinical impression in the written report
Impact: Complete documentation prevents downcoding or denial; missing elements can trigger medical necessity denials worth the full $56.28
When performing ultrasound guidance for thoracentesis or biopsy, bill 76604 for the diagnostic component and add the appropriate guidance code (76942) separately with modifier 59 if both services are distinct
Impact: Captures additional reimbursement of $50-80 for guidance when separately documented and medically necessary
For hospital-based services, ensure proper split of professional (26) and technical (TC) components between radiologist and facility to maximize compliant reimbursement
Impact: Proper component billing prevents duplicate claim denials and ensures both entities receive appropriate payment portions
Link to specific ICD-10 codes supporting medical necessity such as J90 (pleural effusion), R09.1 (pleurisy), or R22.2 (localized swelling, trunk) rather than generic symptoms
Impact: Specific diagnosis coding reduces medical necessity denials by 30-40% and supports LCD/NCD compliance
Verify that images are permanently stored and retrievable for audit purposes; include documentation of image archiving in the procedure note

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76604 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 76604 is $56.28 for both facility and non-facility settings. This rate is based on 1.74 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic location due to locality adjustments.

What is the difference between CPT 76604 and echocardiography codes?

CPT 76604 is used for ultrasound examination of chest structures excluding the heart (chest wall, pleura, diaphragm, mediastinum), while echocardiography codes (93303-93352) are specifically for imaging the heart and cardiac structures. Using 76604 when cardiac structures are evaluated will result in claim denial and requires recoding to the appropriate echocardiography CPT code.

Can I bill CPT 76604 with thoracentesis on the same day?

Yes, but documentation must clearly show 76604 was a separate diagnostic service performed before the decision to do thoracentesis, not just procedural guidance. Use modifier 59 on 76604 to indicate a distinct service, and maintain separate documentation for the diagnostic ultrasound and any guidance provided during the procedure. If only guidance was provided, bill 76942 instead.

How many RVUs is CPT 76604 worth in 2025?

CPT 76604 has a total of 1.74 RVUs in 2025, consisting of 0.59 work RVUs, 1.11 practice expense RVUs (both facility and non-facility), and 0.04 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

What documentation is required to bill CPT 76604?

Required documentation includes a complete written report with interpretation by a qualified physician, permanent stored images (minimum 4-6 representative images), clear medical indication, documentation of all anatomic structures examined, specific findings with measurements, clinical impression, and physician signature with date. Missing any of these elements can result in claim denial or audit recoupment.

Do I need modifier 26 or TC when billing CPT 76604?

Use modifier 26 when billing only the professional component (interpretation and report), typically when a radiologist reads images from a different facility. Use modifier TC when billing only the technical component (equipment and technician), typically when the facility owns the equipment but interpretation is done elsewhere. Bill without modifiers when the same entity provides both components.

What are common medical necessity denials for CPT 76604?

Common medical necessity denials occur when payers require chest X-ray as the first-line imaging, when documentation lacks specific clinical indication, when symptoms are too vague, or when repeat examinations are performed without documented change in clinical status. Always link to specific ICD-10 codes like J90 (pleural effusion) or R22.2 (chest wall mass) rather than generic symptom codes, and document why ultrasound was clinically appropriate.