Procedure

CPT Code*

Ave. Global Reimbursement

Ultrasound, extremity, non-vascular, B-scan and/or real time with documentation, complete

Ultrasound, extremity, non-vascular, B-scan and/or real time with documentation,

limited, anatomic specific (see notes below)

76881

76882

$115.18

$30.24

Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation.

Unbundled example with 20610 (injection of a major joint)

76942

76881, 76942 and 20610

$198.08

$380.26

Procedures per Month

CPT Code	Reimbursement		# Procedures/mth	Total Per Month
76880,76942, 20610	$380 x 20 = $7,600
76942 w/ 20610	$265 x 28 = $7,420
76881 Unilateral	$115 x 20 = $2,300
76881 Multi-Site		$230 x 16 = $3,680
Gross Reimbursement Per Month $21,000
Gross Per Year $252,000

Procedures Per Month Required to Break Even (B.E.)

Monthly Lease Payment	**Average Reimbursement	# of Procedures to B.E.
$252/mth 60mths * / $262 = 1.00/month**
$381/mth 36mths * / $262 = 1.51/month**
$640/mth 60mths / $262 = 2.54/month

Procedures Required to Recoup Equipment Cost

Purchase Price

**Average Reimbursement

# of Procedures

$11,950*** / $262 = 46

$32,900**** / $262 = 126

2011 CPT Code update;

76880 is no longer valid and is being replaced by:

CPT 76881 - Ultrasound, extremity, nonvascular, real-time with image documentation, complete.

CPT Guidelines: A complete ultrasound examination of an extremity consists of real-time scans of a specific joint that includes examination of the muscles, tendons, joint, other soft tissue structures, and any identifiable abnormality.

CPT 76882 - Ultrasound, extremity, nonvascular, real-time with image documentation, limited, anatomic specific.

CPT Guidelines: A limited, anatomic-specific ultrasound examination is performed primarily for evaluation of muscles, tendons, joints, and/or soft tissues. It is a limited examination where a specific anatomic structure such as a tendon or muscle [Moderator Note: or plantar fascia] is being assessed. The code would be used to evaluate a soft-tissue mass that may be present in an extremity where knowledge of its cystic or solid characteristic is needed.

· Ultrasound gel at $17/gal should last ~ 6 months.

· Printer paper $78/box is good for 1,350 prints or 337 patients.

· Use these CPT codes in conjunction with ICD-9 codes.

· If performing a diagnostic ultrasound of the extremities and an ultrasound

guided injection or aspiration during the same patient encounter,

all three codes may be billed: the diagnostic ultrasound (76880),

the ultrasound guidance (76942) and the code for the procedure for

which the guidance was utilized (e.g. 20610). Medicare CCI edits do

not, at present, bundle the extremity ultrasound with the ultrasound

guidance, but some private payers may. Separate recorded images

and written reports for each study should be maintained in the

patient’s record.

· Claims for Bi-Lateral Extremity Ultrasound must have documentation to support its medical necessity. Use –50 modifier.

· Global Amount is for Private Practice Physicians who own their equipment.

*For example only, your reimbursements may be higher or lower depending on your location. Check with your local provider.

**Based on gross reimbursement per month ($21,000) divided by the total number of procedures (80)

*** Lease price based on the base Mindray DP-6600 with a 10% buyout at lease end.

**** Based on an equipment cost of $32,900 with a 10% buyout lease

* A conversion factor of $38.0870 is used in reimbursement calculation as provided for in the Medicare, Medicaid, and SCHIP Extension Act of 2007, which was signed into law on December 29, 2007.

AMA CPT Code Find reimbursement amounts in your area.

Billing Strategies for Regional Anesthesia (w/US)