CPT 76641Radiology

Ultrasound breast complete

CPT code 76641 covers a complete ultrasound examination of the breast, using sound waves to create detailed images of breast tissue. This non-invasive imaging test helps detect abnormalities like cysts, masses, or other breast conditions.

Showing rates for

National Average

Base Medicare rate

$98.98

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

0.73

PE RVU (NF)

2.28

MP RVU

0.05

Total RVU

3.06

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

NCCI bundling edits

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Billing tips

Document whether study is unilateral or bilateral and append appropriate laterality modifiers (RT/LT) to prevent automatic denials
Impact: Prevents 15-25% denial rate for missing laterality documentation; ensures full $98.98 reimbursement without delays
Ensure complete documentation includes all quadrants examined, measurements of any lesions, vascularity assessment, and comparison to prior studies when available
Impact: Reduces audit risk and supports medical necessity; incomplete exams may be downgraded to limited ultrasound codes (76642) with lower reimbursement
Do not bill 76641 with 76642 (limited breast ultrasound) for same breast on same date of service
Impact: 76642 is bundled into 76641; billing both results in automatic denial of 76642 and potential audit flags for unbundling
Verify payer-specific policies on bilateral modifier 50 usage, as Medicare and many commercial payers consider 76641 inherently bilateral
Impact: Incorrect use of modifier 50 may trigger denial or audit; most payers reimburse $98.98 regardless of one or both breasts examined
Link appropriate ICD-10 diagnosis codes supporting medical necessity such as abnormal imaging findings (R92.8), breast lump (N63), or personal history of breast cancer (Z85.3)
Impact: Prevents medical necessity denials; screening-only indications without appropriate diagnosis codes result in 30-40% denial rate
When performed in conjunction with mammography, ensure both studies are medically necessary and documented separately to avoid bundling denials
Proper documentation supports payment for both services; lack of distinct indication may result in denial of ultrasound as included in mammography

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76641 in 2025?

The 2025 Medicare national average payment rate for CPT 76641 is $98.98 for both facility and non-facility settings. This rate is based on the total RVU of 3.06 multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on the Medicare fee schedule locality adjustments.

Is CPT 76641 considered a bilateral procedure?

CPT 76641 describes a complete breast ultrasound and can be performed unilaterally or bilaterally. Medicare and most payers consider 76641 inherently bilateral, meaning the same payment applies whether one or both breasts are examined. When only one breast is examined, append modifier RT (right) or LT (left) for anatomic specificity, but expect the same reimbursement of $98.98.

What is the difference between CPT 76641 and 76642?

CPT 76641 is a complete breast ultrasound examining all quadrants and tissue, while 76642 is a limited breast ultrasound focusing on a specific area or lesion. Code 76641 requires documentation of comprehensive examination of the entire breast, whereas 76642 is used for targeted evaluation of a known finding. The codes cannot be billed together for the same breast on the same date.

Can CPT 76641 be billed with a mammography code on the same day?

Yes, CPT 76641 can be billed with mammography codes (77065-77067) on the same date when both are medically necessary and address distinct clinical needs. Documentation must support separate indications or show that ultrasound provided additional diagnostic information beyond mammography. Payers may scrutinize these combinations, so ensure clinical notes justify both studies.

Do I need modifier 26 or TC when billing CPT 76641?

Use modifier 26 when billing only the professional component (physician interpretation), typically when the procedure was performed at a hospital or facility that bills separately for technical costs. Use modifier TC when billing only the technical component (equipment and staff). When your practice owns the equipment and provides both interpretation and technical services, bill the global code 76641 without modifiers.

What diagnosis codes support medical necessity for CPT 76641?

Common supporting diagnoses include R92.8 (abnormal breast imaging findings), N63.XX (breast lump), N64.4 (breast pain), Z80.3 (family history of breast cancer), Z85.3 (personal history of breast malignancy), and R92.2 (inconclusive mammogram). Screening-only codes without additional supporting clinical findings typically result in denials, as diagnostic breast ultrasound requires specific clinical indication.

How many RVUs is CPT 76641 worth in 2025?

CPT 76641 has a total RVU value of 3.06 in 2025, comprised of 0.73 work RVU, 2.28 practice expense RVU (both facility and non-facility), and 0.05 malpractice RVU. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.