CPT 76942Radiology

Echo guide for biopsy

CPT code 76942 covers ultrasound imaging guidance used during needle biopsies and similar procedures. The physician uses real-time ultrasound to watch the needle on a screen and guide it precisely to the target tissue.

Showing rates for

National Average

Base Medicare rate

$57.25

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

0.67

PE RVU (NF)

1.06

MP RVU

0.04

Total RVU

1.77

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

NCCI bundling edits

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Billing tips

Always bill 76942 separately from the primary biopsy code - it is not bundled into most percutaneous biopsy procedures when ultrasound guidance is actually used and documented
Impact: Recovers the full $57.25 Medicare payment that is commonly missed when billers assume guidance is included in the primary procedure code
Ensure permanent recorded images are stored with measurements and documentation of real-time guidance - vague documentation like 'US guidance used' will trigger denials
Impact: Prevents post-payment audit recoupment and initial denials; audits targeting imaging guidance have recoupture rates exceeding 30% when documentation is insufficient
Check CCI edits before billing 76942 with specific primary procedures - some codes have mutually exclusive edits requiring modifier 59/XU with strong documentation
Impact: Prevents automatic denial; approximately 15-20% of 76942 claims require modifier 59/XU to override bundling edits depending on primary procedure
Do not bill 76942 multiple times for a single biopsy session unless separate, distinct target lesions require independent guidance - multiple passes to same lesion count as one guidance service
Impact: Avoids fraud concerns and denials for duplicate billing; only bill multiple units when truly separate anatomic targets are biopsied in same session
When billing with joint injection codes, verify that ultrasound guidance was truly necessary and not just confirmatory imaging after blind injection
Impact: Pre-injection real-time guidance is reimbursable; post-injection confirmation imaging is not separately billable and may trigger audit flags

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76942 in 2025?

The 2025 Medicare national average reimbursement for CPT 76942 is $57.25 for both facility and non-facility settings. This rate is based on 1.77 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Can CPT 76942 be billed with every biopsy procedure?

No, 76942 should only be billed when ultrasound guidance is actually performed and documented with permanent images showing real-time needle guidance. Check CCI edits for the specific primary procedure code, as some combinations are bundled and require modifier 59/XU with appropriate documentation to bill separately.

What documentation is required to bill CPT code 76942?

Required documentation includes permanently stored ultrasound images with measurements, documentation of real-time needle visualization during advancement, identification of the target structure, description of the needle path, and medical necessity for imaging guidance. Vague statements like 'ultrasound used' are insufficient.

Is CPT 76942 an add-on code or standalone code?

CPT 76942 is a standalone code, not designated as an add-on (+) code, but it is almost always billed with a primary procedure code such as a biopsy, aspiration, or injection code. It should not be billed alone without an associated procedural code.

How many times can you bill 76942 in one session?

Bill 76942 once per separately identified target lesion or anatomic site requiring distinct guidance. Multiple needle passes to the same target count as one guidance service. Billing multiple units requires clear documentation of separate targets in different locations, each requiring independent real-time guidance.

What is the difference between CPT 76942 and 76998?

CPT 76942 is specifically for ultrasonic guidance for needle placement (biopsies, aspirations, injections), while 76998 is for ultrasonic guidance for intraoperative procedures. Code 76998 is used during open surgical procedures, whereas 76942 is used for percutaneous needle procedures.

Do you need modifier 26 when billing CPT 76942 in a hospital?

Modifier 26 (professional component) may be appropriate when the physician provides only the interpretation in a hospital setting where the facility owns the equipment. However, for 76942, the facility and non-facility rates are identical at $57.25, so there is no payment differential. Check individual payer policies as some may not recognize component billing for this code.