CPT 76872Radiology

Us transrectal

CPT code 76872 covers transrectal ultrasound (TRUS), an imaging procedure where a small ultrasound probe is inserted into the rectum to create detailed images of the prostate, rectum, or surrounding pelvic structures.

Showing rates for

National Average

Base Medicare rate

$190.52

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

0.69

PE RVU (NF)

5.16

MP RVU

0.04

Total RVU

5.89

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

NCCI bundling edits

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Billing tips

Verify the exam was diagnostic only without biopsy guidance; if prostatic biopsy was performed, bill 76942 instead of 76872
Impact: Prevents automatic denial and potential recoupment; 76942 pays differently and bundles guidance into the service
Document complete evaluation of all prostatic zones (peripheral, transition, central), seminal vesicles, and prostatic measurements in three dimensions
Impact: Supports medical necessity and complete exam; incomplete documentation can trigger 52 modifier or denial with potential 25-50% payment reduction
Ensure separate, dated physician interpretation report is in medical record with images stored; verbal reports are insufficient
Impact: Medicare audits commonly target imaging codes; missing written reports can result in 100% recoupment of the $190.52 payment
Link to specific ICD-10 codes demonstrating medical necessity such as elevated PSA (R97.20), prostatic nodule (N40.2), or abnormal DRE findings
Impact: Preventive screening alone may not be covered; medical necessity documentation prevents denials and supports the 5.89 total RVUs claimed
Bill globally in non-facility settings to capture full $190.52; in hospital settings, ensure proper 26/TC split between physician and facility
Impact: Incorrect modifier use leaves money on table; both facility and non-facility rates are identical at $190.52 for this code but component splits differ
Do not bill 76872 on same day as 76942 (TRUS with biopsy guidance) for same patient encounter; codes are mutually exclusive
NCCI edits will bundle 76872 into 76942; results in automatic denial and claim reprocessing delays of 30-60 days

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76872 in 2025?

The 2025 Medicare national average reimbursement for CPT 76872 is $190.52 for both facility and non-facility settings. This is based on 5.89 total RVUs (0.69 work RVU + 5.16 PE RVU + 0.04 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 76872 and 76942?

CPT 76872 is for diagnostic transrectal ultrasound only, while 76942 is for transrectal ultrasound guidance during procedures like prostate biopsy. You cannot bill both codes for the same encounter; if a biopsy is performed with ultrasound guidance, only 76942 should be billed as it includes the imaging component.

Can CPT 76872 be billed for prostate cancer screening?

Medicare typically does not cover CPT 76872 for routine screening alone. Medical necessity must be established through clinical findings such as elevated PSA levels, abnormal digital rectal examination, lower urinary tract symptoms, or follow-up of known prostatic abnormalities. Documentation must support diagnostic rather than screening intent.

What documentation is required to bill CPT 76872?

Required documentation includes a complete physician interpretation report with prostatic measurements in three dimensions, evaluation of all prostatic zones and seminal vesicles, permanent stored images, clinical indication, and physician signature. The report must demonstrate a complete diagnostic study was performed and interpreted.

How many RVUs is CPT code 76872 worth?

CPT 76872 has 5.89 total RVUs for 2025, consisting of 0.69 work RVUs, 5.16 practice expense RVUs (both facility and non-facility), and 0.04 malpractice RVUs. The PE RVU is unusually the same for both settings due to the specialized equipment requirements.

Who can perform and bill for CPT 76872?

CPT 76872 is typically performed and billed by urologists and radiologists who have training in transrectal ultrasound imaging. The procedure must be performed by or under the direct supervision of a qualified physician, and the interpreting physician must provide a separate written report to bill for the service.

What ICD-10 codes support medical necessity for CPT 76872?

Common supporting diagnoses include R97.20 (elevated PSA), N40.0-N40.3 (benign prostatic hyperplasia variants), R33.8 (urinary retention), R30.0 (dysuria), C61 (malignant neoplasm of prostate for follow-up), and D07.5 (carcinoma in situ of prostate). Screening codes alone (Z12.5) may not support Medicare coverage.