CPT 76886Radiology

Us exam infant hips static

CPT 76886 is an ultrasound examination of an infant's hips performed without movement to check for developmental hip dysplasia or other abnormalities in babies typically under 6 months old.

Showing rates for

National Average

Base Medicare rate

$96.07

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

0.62

PE RVU (NF)

2.31

MP RVU

0.04

Total RVU

2.97

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

NCCI bundling edits

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Billing tips

Bill as a complete bilateral examination unless documentation clearly indicates only one hip was examined; the code descriptor assumes bilateral imaging
Impact: Prevents downcoding or denials; maintains full $96.07 reimbursement versus potential 50% reduction if payer assumes unilateral
Ensure the physician's report includes measurements (alpha angle, beta angle, or other quantitative assessments) and specific hip stability assessment, not just image descriptions
Impact: Reduces audit risk and supports medical necessity; missing measurements are a top reason for recoupment in post-payment audits
Document the indication clearly, especially for screening versus diagnostic purposes, as some payers have different coverage policies for routine screening
Impact: Medicare and many commercial payers cover diagnostic studies more reliably than screening; proper indication coding can prevent $96.07 denials
Verify patient age at time of service; most payers limit coverage to infants under 6-12 months old without additional justification
Impact: Age-based denials are common and difficult to appeal; proactive verification prevents claim rejections
Do not bill 76886 with 76885 (dynamic infant hip ultrasound) for the same encounter unless both static and dynamic components were performed and documented separately
Impact: Prevents bundling denials and potential fraud allegations; improper concurrent billing can trigger 100% denial of one or both codes
Link appropriate ICD-10 codes for hip dysplasia screening (Z13.89) or specific findings (Q65.x codes) to support medical necessity

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76886 in 2025?

The 2025 Medicare national average reimbursement for CPT 76886 is $96.07 for both facility and non-facility settings, with 2.97 total RVUs based on the CMS Physician Fee Schedule released December 23, 2024.

What is the difference between CPT 76885 and 76886?

CPT 76885 is a dynamic infant hip ultrasound with real-time evaluation of hip movement and stress maneuvers, while 76886 is a static examination with images obtained without movement. Dynamic studies (76885) provide more comprehensive assessment but take longer and reimburse higher; static studies (76886) are appropriate for initial screening in many cases.

At what age should infant hip ultrasound screening be performed?

Infant hip ultrasound for developmental dysplasia screening is typically performed between 6 weeks and 6 months of age, with optimal timing at 4-6 weeks for at-risk infants. Before 4 weeks, physiologic hip laxity can cause false positives; after 6 months, ossification may limit ultrasound visualization and X-ray becomes preferred.

Does Medicare cover CPT 76886 for routine infant hip screening?

Medicare coverage for routine screening varies by MAC, but most require documented risk factors such as breech presentation, positive family history, clinical examination findings, or other risk factors rather than covering universal screening. Commercial payers have varied policies, with many requiring specific indications beyond routine well-child care.

Can CPT 76886 be billed bilaterally or with modifier 50?

No, CPT 76886 is already a bilateral code that assumes evaluation of both hips in its standard reimbursement of $96.07. Do not append modifier 50 or bill twice. If only one hip is examined due to clinical circumstances, documentation should clearly explain why, though some payers may still pay the full bilateral rate.

What diagnosis codes support medical necessity for CPT 76886?

Common supporting ICD-10 codes include Z13.89 (encounter for screening for other disorder), Q65.89 (other specified congenital deformities of hip), R29.4 (clicking hip), P03.89 (newborn affected by other specified complications of labor and delivery including breech), and Z87.81 (personal history of other specified conditions) for family history of DDH.

Who can perform and bill for infant hip ultrasound CPT 76886?

CPT 76886 must be interpreted by a qualified physician, typically a radiologist or physician with documented training in musculoskeletal ultrasound. A registered sonographer or ultrasound technologist may perform the technical component under appropriate supervision, but the professional interpretation must be by a credentialed physician for proper billing.