CPT 76965Radiology

Echo guidance radiotherapy

CPT code 76965 covers ultrasound imaging used to guide and position patients during radiation therapy treatments. This helps ensure the radiation beam precisely targets the tumor while sparing healthy tissue.

Showing rates for

National Average

Base Medicare rate

$92.51

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

1.34

PE RVU (NF)

1.47

MP RVU

0.05

Total RVU

2.86

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

NCCI bundling edits

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Billing tips

Bill 76965 for each treatment session where ultrasound guidance is performed, not once per treatment course
Impact: Proper frequency billing can increase total reimbursement by 20-35 fractions at $92.51 per fraction for a typical treatment course ($1,850-$3,238 total)
Document the specific anatomical structures visualized and verified with ultrasound imaging for each session in the treatment record
Impact: Reduces denial risk by 60-70% by demonstrating medical necessity and distinct service from the radiation treatment delivery code
Ensure ultrasound guidance is billed separately from the radiation treatment delivery code (77385, 77386, 77387) and is not included in the treatment management codes
Impact: Prevents revenue loss of $92.51 per fraction by avoiding incorrect bundling assumptions
Verify LCD/NCD coverage policies for your MAC, as some require specific cancer types or anatomical sites for ultrasound guidance coverage
Impact: Pre-verification prevents denial of entire treatment course imaging, protecting $1,850+ in revenue for typical 20-fraction course
Bill 76965 on the same date of service as the radiation treatment delivery, not separately or in advance
Impact: Ensures proper claim processing and prevents denials for services not performed on the documented treatment date
Do not bill 76965 with other image guidance codes (76950, 77014, 77387) for the same treatment session unless truly distinct and separately documented
Impact: Avoids unbundling denials and potential compliance issues; incorrect billing can trigger audits and recoupment of all imaging payments

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Frequently asked questions

What is CPT code 76965 used for in radiation therapy?

CPT 76965 is used for ultrasound guidance during radiation therapy treatment delivery. It represents real-time ultrasound imaging performed to visualize internal anatomy and verify tumor position before delivering radiation, ensuring accurate targeting and patient setup for each treatment session.

How much does Medicare pay for CPT 76965 in 2025?

Medicare pays $92.51 for CPT 76965 in 2025 based on the national average rate. This applies to both facility and non-facility settings, with a total RVU of 2.86 (1.34 work RVU, 1.47 PE RVU, and 0.05 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 76965 be billed for every radiation treatment session?

Yes, CPT 76965 can typically be billed for each treatment session where ultrasound guidance is actually performed and documented. For a patient receiving daily radiation therapy over 20-35 fractions, this code would be billed separately for each fraction, provided the ultrasound guidance is medically necessary and properly documented each time.

What documentation is required to bill CPT 76965?

Documentation must include the date ultrasound guidance was performed, specific anatomical structures visualized, confirmation of patient positioning verification or adjustment, supervising physician name, and clear linkage to the radiation treatment fraction delivered. Each session requiring billing must have separate documentation showing the service was actually performed.

Can CPT 76965 be billed with other image guidance codes?

Generally, 76965 should not be billed with other image guidance codes (such as 76950, 77014, or the IGRT component of 77387) for the same treatment session, as this may be considered duplicate billing. If multiple imaging modalities are truly medically necessary and distinct, modifier 59 may be appropriate with strong documentation supporting separate services.

What is the difference between CPT 76965 and 77387 for radiation therapy?

CPT 76965 is specifically for ultrasound-based image guidance during radiation delivery, while 77387 is a complex IMRT delivery code that includes simple imaging guidance as part of the service. When ultrasound is used as the primary guidance modality, 76965 is billed separately; however, these codes should not typically be billed together for the same session to avoid unbundling issues.

Do all insurance companies cover CPT 76965 for radiation therapy?

Coverage varies by payer and may depend on the cancer type, treatment site, and medical necessity. Medicare covers 76965 when medically necessary, but some Medicare Administrative Contractors have Local Coverage Determinations specifying which diagnoses or anatomical sites qualify. Commercial payers may have different coverage policies, so verification of benefits before starting a treatment course is recommended to avoid denials.