CPT 77076Radiology

Radex osseous survey infant

CPT code 77076 represents a complete skeletal X-ray survey performed on infants, typically consisting of multiple radiographic views to evaluate all bones in the body. This comprehensive imaging study is most commonly ordered when child abuse or metabolic bone disease is suspected in very young patients.

Showing rates for

National Average

Base Medicare rate

$103.83

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)

2.45

MP RVU

0.06

Total RVU

3.21

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

NCCI bundling edits

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Billing tips

Verify patient age at time of service is documented as under 24 months; most payers restrict 77076 to infants and will deny for older children, requiring individual bone codes instead
Impact: Prevents automatic denial and potential loss of full $103.83 reimbursement versus reduced payment for individual studies
Document the complete protocol followed (AAP or ACR standard) including minimum number of views obtained; incomplete surveys may trigger downcoding to individual X-ray codes with significantly lower total reimbursement
Impact: Protects against downcoding from $103.83 to multiple lower-paying codes (77072 at ~$25-30 each) which could reduce total payment by 40-60%
For suspected child abuse cases, link diagnosis codes for child maltreatment (T74.12XA, T74.92XA) or encounter for suspected abuse ruled out (Z04.72) to establish medical necessity; avoid using screening codes
Impact: Ensures coverage as diagnostic rather than screening service; screening skeletal surveys are typically not covered, risking complete denial of $103.83
Do not unbundle 77076 into individual skeletal X-ray codes (77071-77077) even if multiple body parts are imaged; this is a comprehensive code specifically designed to prevent unbundling
Impact: Unbundling triggers NCCI edits and automatic denials with potential fraud investigation; may result in recoupment and penalties far exceeding the $103.83 payment
Bill facility and non-facility settings at same rate ($103.83) but ensure place of service code is accurate; this is one of the few radiology codes with identical facility/non-facility rates
Impact: Eliminates common billing errors from place of service mismatches that can delay payment by 15-30 days

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Common denials

Patient age exceeds payer's definition of infant (typically >24 months) - denied as not medically necessary or requiring individual bone codes

How to appeal: Submit appeal with documentation of patient's exact age at service date and payer policy language defining age limits. If patient truly exceeds limit, rebill using individual anatomic site codes (77071, 77072, 77075, etc.) with modifier 52 if originally billed as 77076. Include clinical justification for comprehensive survey despite age.

Denied as screening procedure without documented signs/symptoms or clinical suspicion of abuse, metabolic disease, or skeletal dysplasia

How to appeal: Provide complete clinical documentation including referring physician's orders, history and physical findings, emergency department notes, or child protective services involvement. Highlight specific clinical indicators (bruising pattern, fracture mechanism inconsistent with history, laboratory abnormalities) that made skeletal survey diagnostic rather than screening. Correct diagnosis codes to reflect suspected or confirmed condition.

Unbundling edit denial when billed with individual skeletal X-ray codes on same date of service (NCCI edit violations)

How to appeal: If truly separate anatomic areas not included in infant skeletal survey protocol were imaged for distinct clinical reasons, appeal with anatomic documentation and modifier 59 on the separate service. Otherwise, accept denial and do not rebill - 77076 is comprehensive and includes all skeletal areas. Educate coding staff to prevent future unbundling.

Incomplete documentation of all required views per standard protocol, resulting in downcoding to individual body area codes or denial for insufficient documentation

How to appeal: Submit complete imaging report listing all views obtained, comparison to AAP or ACR pediatric skeletal survey protocol, and technical factors. If all protocol views were obtained but not documented in report, request addendum from radiologist specifying complete view list. If incomplete survey was performed due to patient instability, add modifier 52 and accept reduced payment rather than full denial.

Frequently asked questions

What is CPT code 77076 used for?

CPT code 77076 is used for a complete skeletal X-ray survey in infants, which involves taking multiple radiographic images of all bones in the body. This comprehensive study is most commonly performed when there is suspicion of child abuse, non-accidental trauma, metabolic bone disease like rickets, or skeletal dysplasia. The 2025 Medicare reimbursement rate is $103.83.

What is the age limit for billing CPT 77076?

Most payers restrict CPT 77076 to infants under 24 months of age, though some may define infant as under 12 months. For children older than the payer's age limit, the skeletal survey should be billed using individual anatomic site codes rather than the bundled infant survey code. Always verify patient age documentation and payer-specific policies before billing.

How many views are required for CPT code 77076?

CPT 77076 requires a comprehensive skeletal survey following standard protocols such as the American Academy of Pediatrics or American College of Radiology guidelines, typically including minimum views of the skull, chest (AP and lateral), abdomen, pelvis, and all extremities. The exact number varies by protocol (usually 20+ images) but must be documented as a complete survey. Incomplete surveys should be billed with modifier 52 or as individual body area codes.

Can you bill 77076 with other X-ray codes on the same day?

Generally no, because 77076 is a comprehensive code that includes all skeletal areas and is subject to NCCI bundling edits with other skeletal X-ray codes. Billing individual bone codes with 77076 on the same date typically results in denials for unbundling. The only exception would be if a completely separate anatomic area not part of the standard skeletal survey protocol was imaged for a distinct clinical reason, which would require modifier 59 and clear documentation.

What diagnosis codes support medical necessity for CPT 77076?

Medical necessity for 77076 is supported by diagnosis codes including suspected child abuse (T74.12XA, T74.92XA, Z04.72), confirmed abuse (T74.12XD), fractures in various stages of healing, rickets (E55.0), osteogenesis imperfecta (Q78.0), skeletal dysplasias (Q77-Q78 series), and metabolic bone disorders. Screening codes without clinical signs/symptoms typically result in denial as not medically necessary.

Does CPT 77076 require a pediatric radiologist?

While not universally required by all payers, many hospitals and child protection protocols require board-certified pediatric radiologists or radiologists with specialized child abuse training to interpret skeletal surveys in suspected abuse cases. Some state mandatory reporting laws specify radiologist qualifications. Medicare does not specify subspecialty requirements, but medical staff bylaws and legal standards of care often do for forensic cases.

How do you bill a follow-up skeletal survey in child abuse cases?

Follow-up skeletal surveys (commonly performed 2 weeks after initial survey per child abuse protocols) should be billed as a new date of service with CPT 77076 and appropriate diagnosis codes documenting the follow-up nature. If performed same-day as initial survey, use modifier 76. Include documentation explaining the protocol-driven medical necessity for repeat imaging to detect healing fractures that may not have been visible initially. Each survey is separately reimbursable at $103.83 when medically necessary.