CPT 76870Radiology

Us exam scrotum

CPT code 76870 covers an ultrasound examination of the scrotum, which uses sound waves to create images of the testicles and surrounding structures to check for masses, pain, swelling, or other abnormalities.

Showing rates for

National Average

Base Medicare rate

$96.72

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

0.64

PE RVU (NF)

2.3

MP RVU

0.05

Total RVU

2.99

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

NCCI bundling edits

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Billing tips

Always document bilateral examination of both testicles even when pathology is unilateral
Impact: Prevents downcoding or denial; ensures full $96.72 reimbursement rather than potential reduction for incomplete study
Include color or spectral Doppler documentation when evaluating for testicular torsion or varicocele
Impact: Doppler is included in 76870 payment and strengthens medical necessity; do not separately bill Doppler studies as they are bundled
Submit with appropriate ICD-10 codes specifying laterality (right, left, bilateral, or unspecified)
Impact: Specificity in diagnosis coding reduces claim review delays and supports medical necessity; improves first-pass claim acceptance rates by 15-20%
Verify place of service code matches actual location (11 for office, 22 for outpatient hospital, 23 for emergency)
Impact: Both facility and non-facility rates are $96.72, but incorrect POS codes trigger audits and can delay payment
Maintain permanent images with measurements and annotations as part of the medical record
Impact: Required for audit compliance; absence of images can result in full recoupment of the $96.72 payment plus penalties
Do not bill 76870 with limited or follow-up ultrasound code 76857 on the same date of service
Impact: These codes are mutually exclusive; billing both will result in denial of one service and potential audit for unbundling

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76870 in 2025?

The 2025 Medicare national average payment for CPT 76870 is $96.72 for both facility and non-facility settings. This rate is based on 2.99 total RVUs multiplied by the 2025 conversion factor of 32.3465. Local rates may vary based on geographic practice cost indices (GPCI).

Can I bill CPT 76870 for a unilateral scrotal ultrasound?

CPT 76870 describes a complete scrotal ultrasound examination, which inherently includes evaluation of both testicles and surrounding structures. Even when pathology is suspected on one side, documentation should reflect bilateral examination. There is no separate unilateral scrotal ultrasound code; billing 76870 with RT or LT modifiers is generally not appropriate unless truly only one side was examined due to clinical limitations.

Is Doppler included in CPT 76870 or billed separately?

Color and spectral Doppler evaluation is included in CPT 76870 when clinically indicated and should not be billed separately. The code encompasses a complete ultrasound examination including Doppler assessment of testicular vascularity when appropriate for the clinical indication, such as evaluating for torsion or varicocele.

What modifiers are commonly used with CPT code 76870?

The most common modifiers for 76870 are modifier 26 (professional component only) and TC (technical component only) when the service is split between interpreting physician and facility. Modifier 76 may be used for repeat procedures by the same physician on the same day when medically necessary. RT/LT modifiers are rarely appropriate since 76870 assumes bilateral examination.

How many RVUs is CPT 76870 worth in 2025?

CPT 76870 has a total of 2.99 RVUs in 2025, consisting of 0.64 work RVUs, 2.3 practice expense RVUs, and 0.05 malpractice RVUs. Both facility and non-facility practice expense RVUs are 2.3 for this code.

What diagnosis codes support medical necessity for CPT 76870?

Common supporting ICD-10 codes include R10.2 (pelvic and perineal pain), N44.0 (testicular torsion), N50.3 (testicular cyst), N44.1 (cyst of tunica albuginea), N50.8 (other specified disorders of male genital organs), N43.3 (hydrocele), I86.1 (scrotal varices/varicocele), S31.3 (open wound of scrotum and testes), and C62.90 (malignant neoplasm of testis). Laterality specification (right, left, bilateral) improves claim specificity.

Can CPT 76870 be billed with an office visit on the same day?

Yes, CPT 76870 can be billed with an E/M service (office visit) on the same day when the E/M service is separately identifiable and documented. The ultrasound is typically ordered as a result of the office visit. No modifier is needed on 76870, but ensure the E/M note documents the separate evaluation that led to ordering the ultrasound to support medical necessity for both services.