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See a sample rate comparisonCPT 76642 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Ultrasound Breast Limited, Ultrasound Breast Unilateral Real Time With Image Documentation Including Axilla When Performed Limited
| Key Fact | Detail |
|---|---|
| Service Type | Radiology Procedures Diagnostic Ultrasound Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | None LT - Left side of body 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 76642 |
| Medicaid Fee Schedule | View Medicaid rates for 76642 |
National average reimbursement for CPT 76642 by major payers:
$116.46
$104.69
$109.59
$134.42
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CPT 76642
5 of 25 sample ratesHigher to lower in this preview
Rahul Sawlani
$351.80Published rateJohn Matson
University Of Virginia Physicians Group
$127.13Published rateRochelle Nagales Nagamos
Summit Medical Group, P.A.
$88.98Published rateSamuel Apata
Goodwill Diagnostic Services LLC
$54.49Published rateRonald Walsh
St Josephs Hospital Yonkers
$17.89Published rate
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See a sample payer proposalCPT 76642 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76642 code is part of the Radiology Procedures services used for Diagnostic Ultrasound Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 76642 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 76641-CPT | Low | Ultrasound Breast Complete, Ultrasound Breast Unilateral Real Time With Image Documentation Including Axilla When Performed Complete |
| 76642-CPT | Low | Ultrasound Breast Limited, Ultrasound Breast Unilateral Real Time With Image Documentation Including Axilla When Performed Limited |
| 76700-CPT | Low | Ultrasound Abdominal |
| 76705-CPT | Low | Echography Abdominal B-Scan, Echography Abdominal B-Scan Andor Real Time With Imagedocumentation Limited (Eg Single Organ Quadrant Follow-Up) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76642. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76642 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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