CPT 76989Radiology

Dx intraop epcar us chd i&r

CPT code 76989 covers intraoperative ultrasound imaging performed during heart surgery on patients with congenital heart defects. This specialized imaging helps surgeons visualize heart structures in real-time during the operation to guide surgical decisions.

Showing rates for

National Average

Base Medicare rate

$34.61

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

0.7

PE RVU (NF)

0.25

MP RVU

0.12

Total RVU

1.07

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

NCCI bundling edits

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Billing tips

Document that epicardial approach was medically necessary and superior to transesophageal echocardiography (TEE) for the specific clinical situation
Impact: Prevents denials for duplication with TEE codes (93312-93318); protects $34.61 reimbursement
Bill separately from the primary cardiac surgical procedure code; 76989 is not bundled into most congenital heart surgery codes
Impact: Ensures capture of additional $34.61 payment that is often missed when assumed to be included in surgical global
Ensure written interpretation and report is in medical record separate from operative note, documenting specific findings and their impact on surgical management
Impact: Critical for audit defense; absence of separate report is leading cause of full denial or $34.61 recoupment
Verify that the performing physician is credentialed in echocardiography and has privileges for intraoperative ultrasound at the facility
Impact: Prevents credential-based denials and maintains compliance with payer network requirements
When performed multiple times during same surgery (pre- and post-repair), append modifier 76 and document medical necessity for each assessment
Impact: May secure additional payment (potentially 50% or $17.31) for second assessment if clearly justified
Cross-reference with anesthesia documentation to ensure timing and procedural details align, particularly if cardiac anesthesiologist performs the imaging
Impact: Reduces audit risk and coordination of benefits issues; prevents payment delays averaging 30-45 days

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Frequently asked questions

What is CPT code 76989 used for?

CPT code 76989 is used for diagnostic intraoperative epicardial ultrasound performed during congenital heart disease surgery. It includes both the image acquisition and the physician's interpretation with a written report, helping surgeons assess cardiac structures and repair adequacy in real-time during the operation.

How much does Medicare pay for CPT 76989 in 2025?

Medicare pays $34.61 for CPT 76989 in 2025 based on the national average rate. This applies to both facility and non-facility settings. The code has 1.07 total RVUs (0.7 work RVU, 0.25 practice expense RVU, 0.12 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Is CPT 76989 bundled into congenital heart surgery codes?

No, CPT 76989 is generally separately reportable and not bundled into most congenital heart surgery codes. However, you must document medical necessity and provide a separate written interpretation report. Some payers may have specific bundling edits, so verify individual payer policies before billing.

Can I bill both 76989 and transesophageal echo during the same surgery?

Yes, but documentation must clearly justify why both epicardial ultrasound (76989) and transesophageal echocardiography were medically necessary. You should document specific clinical reasons why each approach provided unique information essential to surgical management. Consider using modifier 59 or XU to indicate distinct services.

Who can bill CPT 76989?

CPT 76989 can be billed by physicians who perform and interpret the intraoperative epicardial ultrasound, typically pediatric cardiologists, adult congenital cardiologists, or cardiac anesthesiologists with appropriate echocardiography training and credentials. The physician must personally perform or directly supervise the imaging and provide a written interpretation.

What documentation is required to bill 76989?

Required documentation includes clinical indication, ultrasound technique, specific structures visualized, measurements obtained, assessment of findings, images stored, and a written interpretation separate from the operative note. The report must document how the imaging impacted surgical decision-making and be signed by the interpreting physician.

What modifiers are commonly used with CPT 76989?

Common modifiers for 76989 include modifier 59 or XU (distinct procedural service when billed with other imaging), modifier 76 (repeat procedure if multiple assessments during same surgery), and modifier AS (when performed by physician assistant or nurse practitioner assisting at surgery). Modifier 26 is not typically applicable as 76989 represents professional component only.