CPT 76873Radiology

Echograp trans r pros study

CPT code 76873 covers a transrectal ultrasound examination of the prostate gland, where a small ultrasound probe is inserted into the rectum to create detailed images of the prostate for diagnostic purposes.

Showing rates for

National Average

Base Medicare rate

$169.50

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

1.55

PE RVU (NF)

3.62

MP RVU

0.07

Total RVU

5.24

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

NCCI bundling edits

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Billing tips

Bill 76873 separately from biopsy codes (55700) as this is the diagnostic study component; document that complete transrectal imaging was performed even when biopsy follows
Impact: Ensures full $169.50 reimbursement instead of bundled denial; can add $150-170 to claim value
Document prostate volume measurements in cubic centimeters (length x width x height x 0.52) in the final report to demonstrate complete study
Impact: Reduces audit risk and supports medical necessity; volumetric data strengthens documentation for Medicare reviews
Archive permanent images with anatomic labels showing transverse and sagittal views as required by Medicare for all ultrasound studies
Impact: Prevents 100% recoupment demands during CERT or ZPIC audits; required for payment retention
Do not bill 76873 on same day as 76872 (limited transrectal ultrasound) as Medicare considers these mutually exclusive; use only the complete study code
Impact: Prevents automatic denial of both codes; protects full $169.50 payment
When performed in ASC or hospital setting, verify facility versus non-facility status; 76873 has identical rates ($169.50) but modifier 26 requirements differ
Impact: Ensures proper component billing; prevents overpayment recovery and compliance issues
Link appropriate ICD-10 diagnosis codes (R97.2 elevated PSA, N40.0 enlarged prostate, Z12.5 prostate screening) to establish medical necessity
Impact: Reduces denial rate by 30-40%; screening codes may not be covered without additional symptoms documented

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76873 in 2025?

The 2025 Medicare national average reimbursement for CPT 76873 is $169.50 for both facility and non-facility settings, based on 5.24 total RVUs and the conversion factor of $32.3465.

Can you bill CPT 76873 with a prostate biopsy on the same day?

Yes, CPT 76873 (diagnostic transrectal ultrasound) can be billed separately from prostate biopsy code 55700, but not with 76942 (ultrasound guidance for biopsy) which bundles. The diagnostic study must be complete, documented separately, and medically necessary independent of the biopsy procedure.

What is the difference between CPT 76872 and 76873?

CPT 76872 is a limited transrectal ultrasound (fewer images, focused evaluation) while 76873 is a complete transrectal prostate study requiring comprehensive imaging in multiple planes with full documentation. They are mutually exclusive and cannot be billed together for the same encounter.

How many RVUs is CPT code 76873 worth in 2025?

CPT 76873 has 5.24 total RVUs in 2025, consisting of 1.55 work RVUs, 3.62 practice expense RVUs, and 0.07 malpractice RVUs, equally applicable in both facility and non-facility settings.

What diagnosis codes support medical necessity for CPT 76873?

Common supporting diagnosis codes include R97.2 (elevated PSA), N40.0-N40.3 (enlarged prostate with or without LUTS), R33.8 (urinary retention), C61 (prostate cancer for surveillance), and R97.20 (elevated prostate specific antigen). Pure screening codes (Z12.5) may require additional symptoms for Medicare coverage.

Do I need modifier 26 when billing CPT 76873 in a hospital?

Yes, when performed in a hospital or facility that owns the equipment, physicians must append modifier 26 to bill only for the professional component (interpretation). The facility bills the technical component separately with modifier TC or without a modifier.

What images must be permanently stored for CPT 76873 compliance?

Medicare requires permanent storage of representative images in both transverse and sagittal planes showing the entire prostate gland, including measurements and any abnormalities. Images must include patient identification, facility information, date, and anatomic orientation markers to satisfy documentation requirements during audits.