CPT 76940Radiology

Us guide tissue ablation

CPT code 76940 covers ultrasound imaging guidance used during tissue ablation procedures, where a physician uses real-time ultrasound images to guide instruments that destroy abnormal tissue. This is an add-on service to the primary ablation procedure.

Showing rates for

National Average

Base Medicare rate

$97.04

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

PE RVU (NF)

0.72

MP RVU

0.28

Total RVU

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

NCCI bundling edits

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Billing tips

Always verify that 76940 is being billed as an add-on to a primary ablation procedure code (such as 50250, 47382, 32998, or 19105). This code cannot be billed independently.
Impact: Prevents automatic denials that delay payment by 30-60 days; ensures the full $97.04 reimbursement
Document all phases of ultrasound guidance including pre-procedure targeting, real-time guidance during probe placement, monitoring during ablation, and post-ablation assessment in the operative report
Impact: Reduces audit risk and supports medical necessity; missing documentation is the #1 cause of recoupment in post-payment audits
Confirm payer-specific bundling rules as some commercial payers bundle 76940 into the primary ablation code while Medicare allows separate billing
Impact: Can affect 15-30% of claims; prevents denials and write-offs averaging $97.04 per incorrectly billed case
When multiple ablations are performed in different anatomic sites during the same session, append modifier 59 to the second ablation's guidance code to indicate distinct service
Impact: Captures additional $97.04 per site that would otherwise be denied as duplicate service
Use modifier 26 in facility settings where the hospital owns the ultrasound equipment to bill only the professional component
Impact: Ensures correct payment split and avoids overpayment flags that trigger payer audits
Verify that permanent images from the ultrasound guidance are stored in PACS or medical record with documentation of what anatomic structures and pathology were visualized
Required for compliance; missing images can result in 100% recoupment during audits

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 76940 in 2025?

The 2025 Medicare national average reimbursement for CPT 76940 is $97.04 for both facility and non-facility settings. This is based on 3.0 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Can CPT 76940 be billed alone or does it require a primary procedure?

CPT 76940 is an add-on code and cannot be billed independently. It must be reported in conjunction with a primary tissue ablation procedure code such as 50250 (renal ablation), 47382 (liver ablation), or other ablation CPT codes.

What is the difference between CPT 76940 and 76942?

CPT 76940 is specifically for ultrasound guidance during tissue ablation procedures, while 76942 covers ultrasound guidance for needle placement procedures (biopsies, aspirations, injections). The codes are not interchangeable and must match the primary procedure performed.

How many RVUs is CPT code 76940 worth in 2025?

CPT 76940 has 3.0 total RVUs in 2025, consisting of 2.0 work RVUs, 0.72 practice expense RVUs, and 0.28 malpractice RVUs. The PE and MP RVU values are the same for both facility and non-facility settings.

Do I need modifier 26 when billing 76940 in a hospital setting?

Yes, use modifier 26 when billing only the professional component in a hospital or facility setting where the facility owns the ultrasound equipment. The facility will bill the technical component separately. In office settings where you own the equipment, bill the global service without modifier 26.

Can I bill 76940 twice if I perform ablation on two different lesions?

Generally yes, but you must append modifier 59 or XS to the second occurrence and clearly document that separate lesions or anatomic sites required distinct ultrasound guidance. Some payers may have specific policies limiting payment to one unit per session regardless of the number of lesions treated.

What documentation is required to support billing CPT 76940?

Documentation must include a clear statement that ultrasound guidance was used, description of pre-procedure targeting, real-time monitoring during probe placement and ablation, post-procedure assessment, and permanent stored images. The operative report should detail all phases of ultrasound use throughout the ablation procedure.