CPT 76775Radiology

Us exam abdo back wall lim

CPT code 76775 covers an ultrasound examination of the retroperitoneal area (the back wall of the abdomen), which includes organs like the kidneys, aorta, and surrounding structures. This is a limited exam focusing on specific structures rather than a complete abdominal survey.

Showing rates for

National Average

Base Medicare rate

$58.87

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

0.58

PE RVU (NF)

1.2

MP RVU

0.04

Total RVU

1.82

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

NCCI bundling edits

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Billing tips

Clearly document the limited nature of the exam and specific structures visualized to justify 76775 versus complete retroperitoneal exam (76770)
Impact: Prevents downcoding from complete exam codes and avoids $20-40 reimbursement discrepancies
Split professional and technical components (modifiers 26/TC) only when different entities provide interpretation versus scanning
Impact: Ensures proper payment distribution; incorrect splitting can delay payment or trigger audits
Document medical necessity when performing 76775 on same day as other abdominal imaging to support modifier 59
Impact: Prevents automatic bundling denials that would result in $58.87 payment loss
Use specific anatomic laterality modifiers (RT/LT) for unilateral kidney examinations to improve claim specificity
Impact: Reduces payer inquiries and speeds claim processing by 15-20%
Verify that permanent images are stored and interpretation is documented in medical record within 24-48 hours
Impact: Essential for audit defense; missing documentation can result in full recoupment of $58.87 per claim
Check payer-specific policies on limited ultrasound frequency limits, especially for Medicare Advantage plans
Impact: Prevents denials for exceeding frequency limits; some plans restrict to one exam per 90 days without prior authorization

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76775 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 76775 is $58.87 for both facility and non-facility settings. This is based on 1.82 total RVUs multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 76775 and 76770?

CPT 76775 is a limited ultrasound of the retroperitoneum focusing on specific structures or a targeted area, while 76770 is a complete retroperitoneal ultrasound examining all retroperitoneal structures comprehensively. The limited exam (76775) reimburses at $58.87 compared to higher reimbursement for the complete exam.

Can you bill CPT 76775 with modifier 26 for professional component only?

Yes, modifier 26 can be appended to 76775 when billing only the professional component (physician interpretation) separately from the technical component. This is appropriate when different entities provide the technical performance and professional interpretation services.

What structures are typically examined under CPT code 76775?

CPT 76775 typically examines specific retroperitoneal structures including kidneys, aorta, inferior vena cava, ureters, or targeted retroperitoneal masses. The key is that it's a limited exam focusing on particular structures rather than a comprehensive survey of all retroperitoneal anatomy.

How many RVUs is CPT 76775 worth in 2025?

CPT 76775 has a total RVU value of 1.82 in 2025, consisting of 0.58 work RVUs, 1.2 practice expense RVUs (both facility and non-facility), and 0.04 malpractice RVUs according to the CMS Physician Fee Schedule.

Can CPT 76775 be billed bilaterally for kidney ultrasounds?

No, CPT 76775 is not a bilateral procedure code. It represents a limited exam of retroperitoneal structures regardless of laterality. When examining both kidneys in a limited fashion, use 76775 once. Use RT/LT modifiers only to specify laterality when examining a single kidney, but do not bill twice for bilateral examination.

What documentation is required to bill CPT 76775 to Medicare?

Documentation must include the clinical indication, specific retroperitoneal structures examined, measurements and findings, permanent stored images, physician interpretation with signature, and clear statement that this was a limited exam. The report should specify which structures were examined and justify the limited scope versus a complete retroperitoneal ultrasound.