CPT 76885Radiology

Us exam infant hips dynamic

CPT code 76885 covers a specialized ultrasound examination of an infant's hips using dynamic techniques to check for developmental dysplasia or instability. The radiologist moves the baby's hips during the scan to assess how the hip joint functions in real-time.

Showing rates for

National Average

Base Medicare rate

$130.36

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

0.74

PE RVU (NF)

3.23

MP RVU

0.06

Total RVU

4.03

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

NCCI bundling edits

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Billing tips

Document both static and dynamic components explicitly in the report, specifically naming the Barlow and Ortolani maneuvers performed and the Graf classification measurements taken
Impact: Prevents downcoding to 76886 (limited hip ultrasound) which would reduce reimbursement by approximately 30-40%; ensures full $130.36 payment
Bill 76885 once regardless of whether one or both hips are examined, as the code descriptor is inherently bilateral for infant hip screening
Impact: Prevents automatic denials for duplicate billing; some practices incorrectly bill with modifier 50 or bill twice, resulting in 50% payment reduction or full denial
Verify patient age at time of service is documented as under 12 months (ideally under 6 months) to support medical necessity, as this code is age-specific
Impact: Age over 6 months may trigger medical necessity denials unless special clinical circumstances are documented; prevents denials worth $130.36 per claim
Ensure the ordering diagnosis supports screening (family history, breech presentation, clinical instability) or diagnostic indications per AAP guidelines
Impact: Universal screening without risk factors may be denied by some payers as not medically necessary; proper ICD-10 coding increases clean claim rate by 15-20%
Do not bill 76885 with 76886 on the same date of service for the same anatomic area, as 76886 is a component of the complete dynamic examination
Impact: Violates NCCI edits; results in denial of the lesser-valued code with no modifier override available; prevents payment loss
Submit claims within 30-45 days of service date for commercial payers to avoid timely filing denials, particularly for newborn screening exams where insurance verification may be delayed

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76885 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 76885 is $130.36 for both facility and non-facility settings. This is based on a total RVU of 4.03 (0.74 work RVU, 3.23 practice expense RVU, 0.06 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 76885 be billed bilaterally with modifier 50?

No, CPT 76885 should not be billed with modifier 50 or billed twice for bilateral examinations. The code descriptor inherently includes examination of both hips as standard practice for infant hip dysplasia screening. Billing bilaterally will result in denials or incorrect 50% payment reduction.

What is the difference between CPT 76885 and 76886?

CPT 76885 is a complete dynamic ultrasound examination of infant hips including stress maneuvers (Barlow and Ortolani tests) to assess stability and dysplasia. CPT 76886 is a limited or follow-up hip ultrasound without the comprehensive dynamic assessment, typically used for monitoring known conditions. 76885 requires documentation of dynamic techniques and provides higher reimbursement.

At what age should CPT 76885 be performed for DDH screening?

CPT 76885 is most commonly performed in infants from birth to 6 months of age, with optimal imaging between 4-6 weeks when ossification has not yet obscured ultrasound visualization. After 6 months, plain radiographs (X-rays) typically replace ultrasound as the femoral head ossifies. Some payers may deny as not medically necessary after 6 months unless special circumstances are documented.

What diagnosis codes support medical necessity for CPT 76885?

Common supporting ICD-10 codes include Z32.2 (encounter for childbirth instruction), Z38.00-Z38.01 (liveborn infant codes with breech presentation history), Q65.0-Q65.9 (congenital deformities of hip), R29.898 (other symptoms and signs involving the musculoskeletal system including hip clicks), and Z82.79 (family history of congenital malformations). Breech presentation (O32.1, O64.1) history strongly supports screening.

How many RVUs is CPT code 76885 worth?

CPT 76885 has a total RVU value of 4.03 for 2025, consisting of 0.74 work RVUs (physician effort), 3.23 practice expense RVUs (equipment and staff costs), and 0.06 malpractice RVUs. The practice expense RVU is identical in both facility and non-facility settings at 3.23.

Can CPT 76885 be billed with an E/M code on the same day?

Yes, CPT 76885 can be billed with an evaluation and management (E/M) service on the same day if the E/M represents a significant, separately identifiable service beyond ordering the imaging study. The E/M code should be appended with modifier 25, and documentation must clearly demonstrate the separate nature of the services. The ultrasound code 76885 itself does not require a modifier.