CPT 76975Radiology

Gi endoscopic ultrasound

CPT code 76975 covers gastrointestinal endoscopic ultrasound, a specialized imaging technique that combines endoscopy with ultrasound to examine the digestive tract walls and nearby organs. This is a professional component code used when a physician interprets ultrasound images obtained during an endoscopic procedure.

Showing rates for

National Average

Base Medicare rate

$38.82

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

0.81

PE RVU (NF)

0.36

MP RVU

0.03

Total RVU

1.2

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

NCCI bundling edits

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Billing tips

Always verify that 76975 is billed in addition to the primary endoscopy procedure code (43231, 43232, 43237, 43238, 43242, 43259, 45341, 45342) and not as a standalone service
Impact: Prevents denials for lack of medical necessity; bundling errors can delay payment by 30-60 days
Document the specific ultrasound findings separately from the endoscopic findings in the procedure report, including depth of imaging, structures visualized, and abnormalities identified
Impact: Reduces audit risk by 60-70%; inadequate documentation is the primary reason for 76975 denials on audit
Verify payer-specific policies on bundling as some commercial payers consider 76975 inclusive of the endoscopy procedure despite CMS allowing separate billing
Impact: Pre-verification prevents automatic denials; approximately 15-20% of commercial payers bundle this code
When billing for both diagnostic and therapeutic EUS procedures, ensure 76975 is only reported once per session regardless of number of interventions
Impact: Prevents duplicate billing denials and potential fraud allegations; overpayment recovery can be 2-3x the original payment
Link appropriate diagnosis codes indicating the medical necessity for ultrasound guidance (e.g., pancreatic mass, submucosal lesion, staging codes)
Impact: Improves first-pass acceptance rate by 25-30%; vague or incomplete diagnosis coding triggers manual review
For facility billing, recognize that 76975 pays the same in both facility and non-facility settings ($38.82), so setting-specific coding differences do not apply
Eliminates confusion in multi-site practices; ensures consistent revenue expectations across locations

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76975 in 2025?

The 2025 Medicare national average reimbursement for CPT 76975 is $38.82 for both facility and non-facility settings. This rate is based on 1.2 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Can CPT 76975 be billed with upper endoscopy codes?

Yes, CPT 76975 can be billed separately with upper endoscopy codes (such as 43235, 43237, 43238) when endoscopic ultrasound is performed and separately interpreted. However, you must document the ultrasound component separately and verify that your payer does not bundle these services.

What is the difference between CPT 76975 and 76942?

CPT 76975 is specific to gastrointestinal endoscopic ultrasound guidance, while 76942 covers general ultrasonic guidance for needle placement (biopsies, injections). 76975 is used during endoscopic procedures of the GI tract, whereas 76942 applies to percutaneous or non-endoscopic ultrasound guidance procedures.

Does CPT 76975 require a modifier 26 for physician billing?

Generally no. CPT 76975 is inherently a professional interpretation service and does not typically require modifier 26. However, verify your specific billing scenario and payer requirements, as some situations may warrant modifier use to clarify service components.

How many RVUs is CPT code 76975 worth in 2025?

CPT 76975 has 1.2 total RVUs in 2025, comprised of 0.81 work RVUs, 0.36 practice expense RVUs (both facility and non-facility), and 0.03 malpractice RVUs according to the CMS Physician Fee Schedule.

What documentation is required to bill CPT 76975?

Documentation must include the indication for endoscopic ultrasound, structures examined with ultrasound, wall layer visualization, measurements of abnormalities, assessment of invasion depth or adjacent structures, and a separate interpretation statement distinguishing ultrasound findings from standard endoscopic findings. Images must be stored in retrievable format.

Can CPT 76975 be billed multiple times on the same day?

Generally, 76975 should only be reported once per endoscopic session regardless of how many therapeutic interventions are performed. Multiple billings on the same day would require distinct procedures at different anatomic sites with separate documentation and appropriate modifiers (59, 76, or 77) to avoid denials.