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2025 CPT code 76999

Unlisted ultrasound procedure (diagnostic or interventional).

Adhere to all relevant CPT coding guidelines for unlisted procedures.The use of 76999 should be a last resort, only when a suitable alternative code does not exist.Thorough documentation supporting medical necessity and the unique nature of the procedure is essential.

Modifiers may be applicable depending on the circumstances of the service.Refer to the current CPT manual for appropriate modifier usage.

The medical necessity of the unlisted ultrasound procedure must be clearly documented.This includes the clinical indication, why the procedure was necessary, why other available codes were not appropriate, and the expected benefit to the patient.Documentation must be sufficient to meet the requirements of the payer.

The physician or qualified healthcare professional performing the ultrasound examination and interpreting the results. This involves selecting the appropriate ultrasound technique, obtaining clear images, documenting the procedure and findings in detail and ensuring proper documentation for billing purposes.

IMPORTANT:Consider using a more specific CPT code with appropriate modifiers if one exists that closely approximates the service performed. If a Category III code is available, it should be used in place of 76999.If no other suitable code exists, detailed documentation is crucial to justify the use of this unlisted code.

In simple words: This code is used when an ultrasound test is done, but there isn't a specific code for the exact type of test performed.The doctor will need to fully explain the reason for the test, how it was done, and what the results showed.

This CPT code, 76999, reports an ultrasound procedure not otherwise specified by a standard, active CPT code.It encompasses both diagnostic and interventional ultrasound applications.The procedure must be fully documented, including the reason for performing the unlisted procedure, a detailed description of the technique used, and the results obtained.Supporting documentation should justify medical necessity and the absence of a more specific code.

Example 1: A patient presents with a complex abdominal mass of unknown etiology.A standard abdominal ultrasound is insufficient to fully characterize the mass. The physician performs a specialized ultrasound technique (e.g., contrast-enhanced ultrasound) not explicitly covered by other CPT codes, using 76999 for billing., A patient requires an interventional ultrasound-guided procedure to drain a fluid collection in a location not specifically addressed by other CPT codes.The physician uses specialized equipment and technique, accurately documenting the procedure for billing with 76999., During a complex surgical procedure, the surgeon utilizes ultrasound guidance to place a specialized instrument or drain, requiring a technique not specifically addressed by established codes. The surgeon documents the use of this specialized ultrasound guidance, which would be billed under 76999.

* Detailed description of the procedure performed, including the indication for the unlisted code.* Images of the ultrasound scan.* Measurements and other relevant quantitative data obtained during the study.* Complete report detailing the findings of the examination.* Justification for the use of the unlisted code based on the absence of a more specific CPT code.

** Payment for 76999 is subject to payer-specific policies.Submitting a detailed explanation of the procedure along with the claim is highly recommended to facilitate accurate reimbursement.Consult with your billing department or a medical coding specialist for specific payer guidelines.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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iFrame™ AI's knowledge is aligned with and limited to the materials uploaded by users and should not be interpreted as medical, legal, or any other form of advice by iFrame™.