CPT 76988Radiology

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CPT code 76988 covers ultrasound elastography, a specialized imaging technique that measures tissue stiffness using ultrasound waves. This is commonly used to assess liver fibrosis, breast lesions, and other conditions where tissue elasticity provides diagnostic information.

Showing rates for

National Average

Base Medicare rate

$58.22

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

1.2

PE RVU (NF)

0.43

MP RVU

0.17

Total RVU

1.8

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

NCCI bundling edits

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Billing tips

Always bill 76988 as an add-on code with the primary ultrasound examination code (never alone)
Impact: Standalone billing results in automatic denials; proper pairing ensures the full $58.22 reimbursement
Document the specific elastography technique used (compression elastography vs. shear wave) and clinical indication
Impact: Detailed documentation reduces audit risk and supports medical necessity, preventing up to 100% payment recoupment
Verify payer-specific coverage policies as many commercial payers have limited coverage for elastography
Impact: Preauthorization when required prevents denials; some payers only cover for specific indications like liver fibrosis staging
Ensure separate image documentation of elastography findings distinct from conventional ultrasound images
Impact: Lack of distinct elastography images is a common audit finding leading to claim denials and recoupment
Check for facility vs. non-facility status as 76988 has identical rates ($58.22) but documentation requirements may differ
Impact: Understanding setting-specific requirements prevents compliance issues despite identical reimbursement rates
Review National Coverage Determination (NCD) and Local Coverage Determination (LCD) updates quarterly for elastography indications
Impact: Coverage policies change frequently; staying current prevents denials and supports appropriate utilization

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76988 in 2025?

The 2025 Medicare national average reimbursement for CPT 76988 is $58.22 for both facility and non-facility settings. This rate is based on 1.8 total RVUs (1.2 work RVU, 0.43 practice expense RVU, 0.17 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT code 76988 be billed alone or does it require a primary procedure code?

CPT 76988 is an add-on code and cannot be billed alone. It must always be reported with a primary ultrasound examination code such as 76536 (breast ultrasound), 76700 (abdominal ultrasound), or 76641 (breast ultrasound with elastography). Standalone billing will result in automatic claim denial.

What documentation is required to bill CPT 76988 for ultrasound elastography?

Required documentation includes: explicit statement that elastography was performed, the specific technique used (shear wave or compression), clinical indication, separate elastography images, quantitative measurements (kPa or strain ratio), interpretation of elastography findings, and anatomic location examined. The documentation must clearly show work beyond the primary ultrasound examination.

Which medical specialties commonly bill CPT code 76988?

Radiology and gastroenterology/hepatology are the primary specialties billing 76988, particularly for liver fibrosis assessment. Breast surgeons and radiologists also use it for breast lesion characterization. Other specialties include interventional radiology, obstetrics/gynecology, and endocrinology for thyroid nodule evaluation.

What are the most common denial reasons for CPT 76988?

The most common denials include: billing as a standalone code without a primary ultrasound procedure, lack of medical necessity documentation, insufficient proof of separate elastography image acquisition, and duplicate service denials when bundled with comprehensive ultrasound codes. Proper pairing and detailed documentation prevent most denials.

Is CPT 76988 covered by Medicare for liver fibrosis staging?

Medicare coverage for 76988 varies by jurisdiction and specific Local Coverage Determinations (LCDs). While many Medicare Administrative Contractors (MACs) cover ultrasound elastography for liver fibrosis staging in chronic liver disease, providers must verify their local MAC policy and ensure documentation supports medical necessity for the specific clinical indication.

What modifiers are commonly used with CPT code 76988?

Common modifiers include TC (technical component) when billing separately from interpretation, 59 (distinct procedural service) to prevent bundling when performed at different sites, 76 (repeat procedure) for medically necessary repeat imaging same day, and RT/LT (laterality) for bilateral structures like breasts or thyroid lobes. Modifier 26 is rarely applicable as 76988 is primarily a technical code.