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76642
Quick jump to procedure code: Printer Friendly Version
76705

CPT® 76700: ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE

Short Description: Us exam abdom complete

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
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TEXAS-Rest of Texas
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WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2016 Physician
Fee Schedule:

Global Fee $124.32
* 26 Modifier $ 41.20
* TC Modifier $ 83.12

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 JulyUnadjusted OPPS Payment $153.58


*Based on National 2013 Medicare Part B submitted claims.
Revenue Code(s):
402-Other imaging services-ultrasound


2016 APC Code: 5532
Level 2 Ultrasound and Related Services

Composite APC: 8004
Ultrasound Composite

2016 OPPS Status Indicator: Q3

* This procedure is subject to the Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures - CMS Transmittal 1104

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
20.7% 789.00    Abdominal pain, unspecified site R10.9   Unspecified abdominal pain
5.3% 789.01    Abdominal pain, right upper quadrant R10.11   Right upper quadrant pain
5.0% 574.20    Calculus of gallbladder without cholecystitis without mention of obstruction K80.20   Calculus of gallbladder without cholecystitis without obstruction
3.6% 593.2    Cyst of kidney, acquired N28.1   Cyst of kidney, acquired
3.3% 571.8    Other chronic nonalcoholic liver disease K76.0   Fatty (change of) liver, not elsewhere classified
OR:
K76.89   Other specified diseases of liver
2.8% 789.07    Abdominal pain, generalized R10.84   Generalized abdominal pain
2.4% 789.06    Abdominal pain, epigastric R10.13   Epigastric pain
2.2% 573.8    Other specified disorders of liver K76.1   Chronic passive congestion of liver
OR:
K76.89   Other specified diseases of liver
2.1% 794.8    Abnormal results of function studies, liver R94.5   Abnormal results of liver function studies
1.8% 790.6    Other abnormal blood chemistry R78.89   Finding of other specified substances, not normally found in blood
OR:
R79.0   Abnormal level of blood mineral
OR:
R79.89   Other specified abnormal findings of blood chemistry

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

76700 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 76700

CCI and MUE Edits*         Hide this section.

CCI Edits for 76700
Denied Codes (1)
Effective
Modifier
Accepted (2)
58356 Endometrial cryoablation
01/01/2005 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
51701 Insert bladder catheter
04/01/2003 Yes
51702 Insert temp bladder cath
04/01/2003 Yes
76705 Echo exam of abdomen
01/01/1996 Yes
76942 Echo guide for biopsy
07/01/2016 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
76998 Us guide intraop
01/01/2007 Yes
G0471 Ven blood coll snf/hha
07/01/2015 Yes
91200 Liver elastography
01/01/2015 Yes
93975 Vascular study
01/01/2004 Yes
93976 Vascular study
01/01/2004 Yes
G6015 Radiation tx delivery imrt
01/01/2015 Yes
G6016 Delivery comp imrt
01/01/2015 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 76700.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 76700


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   76700 Top 5 Ordering Providers National*
DANIEL SHIFTEH -NEW YORK,NY 1,817
DAVID CHEN -SAN GABRIEL,CA 1,727
CLIFFORD BEINART -NEW YORK,NY 1,627
DIMITRY HIKIN -LONG ISLAND CITY,NY 1,097
THANH PHUNG -LAWNDALE,CA 1,014

   76700 Top 5 Ordering Organizations National*
AMERICAN DIAGNOSTICS SERVICES, INC.-NJ 10,338
SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC-MD 5,163
SONOGRAPHICS IMAGING INC-NY 2,331
KAN-DI-KI, LLC-CA 1,873
MULTI MOBILE IMAGING, INC.-NY 1,543

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 76700*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 1,149,040
Total Services Denied 2015: 68,693 (6.0%)
National Charges Submitted 2015: $257,259,324.00
National Charges Allowed 2015: $ 78,054,748.00
National Average (No Modifier) Fee Submitted 2015: $344.19
National Average (No Modifier) Fee Allowed 2015: $130.71
National Average (26) Fee Submitted 2015: $152.59
National Average (26) Fee Allowed 2015: $ 40.66
National Average (TC) Fee Submitted 2015: $276.21
National Average (TC) Fee Allowed 2015: $ 83.48


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 863,924 75.2% $207.67 45,840 5.3%
Independent Diagnostic Testing Facility
(IDTF)
(eff. 6/98)
117,154 10.2% $286.73 10,148 8.7%
Internal medicine 59,640 5.2% $259.17 3,652 6.1%
Family practice 31,939 2.8% $257.37 2,224 7.0%
Gastroenterology 21,267 1.9% $283.97 1,557 7.3%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 495,949 43.2% $306.46 36,772 7.4%
Outpatient hospital 357,011 31.1% $155.73 13,703 3.8%
Inpatient hospital 187,185 16.3% $157.00 9,893 5.3%
Emergency room - hospital 50,429 4.4% $154.33 2,759 5.5%
Nursing facility 28,806 2.5% $201.82 3,228 11.2%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 686,535 59.7% $152.60 32,150 4.7%
No Modifier 327,238 28.5% $344.19 25,654 7.8%
TC - Technical Component 91,140 7.9% $276.22 7,184 7.9%
59 - Distinct Procedural Service 23,554 2.0% $322.78 2,469 10.5%
GA - Advanced Beneficiary Notice (ABN) on File 5,794 0.5% $320.09 321 5.5%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


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All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

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