CPT 76872 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Radiology Procedures • Diagnostic Ultrasound Procedures |
| Common Place of Service | • 11 - Office • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 76872 by major payers:
$202.80
$165.25
$166.78
$244.30
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 76872 | ||||||
United | 76872 | $262.04 | 1124260351 - ADRIENNE LAURY | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Otolaryngology Physician (207Y00000X) |
United | 76872 | $85.80 | 1801098405 - ROBIN LEE | 912073120 | WA | Urology Physician (208800000X) |
United | 76872 | $39.59 | 1225457773 - CAMPBELL BRYSON | 910843135 | WA | Urology Physician (208800000X) |
United | 76872 | $216.13 | 1720166812 - EUGENE HONG | 911939739 - FRANCISCAN MEDICAL GROUP | WA | Urology Physician (208800000X) |
United | 76872 | $125.58 | 1356055016 - BELUGA HEALTH PC | 921535934 - BELUGA HEALTH PC | WA | Multi-Specialty Clinic/Center (261QM1300X) |
United | 76872 | $339.75 | 1962587774 - CHRISTIAN KUHR | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Urology Physician (208800000X) |
United | 76872 | $159.88 | 1487809703 - JAMIE LITVACK | 911602128 - (WA) WESTERN WASHINGTON MEDICAL GROUP, INC., P.S. | WA | Otolaryngology Physician (207Y00000X) |
United | 76872 | $125.58 | 1043997885 - ALICE NALUBAMBA | 821407875 | WA | Multi-Specialty Group (193200000X) |
United | 76872 | $294.63 | 1487696092 - TIMOTHY RODDY | 942958258 - BANNER-UNIVERSITY MEDICAL GROUP | WA | Urology Physician (208800000X) |
United | 76872 | $296.08 | 1629031752 - WILLIAM ANDERSON | 910214500 - THE EVERETT CLINIC, PLLC | WA | Allergy & Immunology Physician (207K00000X) |
United | 76872 | $484.02 | 1710912340 - TRACY ERIKSSON | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Otolaryngology Physician (207Y00000X) |
United | 76872 | $125.58 | 1104256445 - C & C MEDICAL ASSOCIATES, PLLC, CCM PEDIATRICS | 461774055 - (WA) C & C MEDICAL ASSOCIATES, PLLC | WA | Multi-Specialty Group (193200000X) |
United | 76872 | $187.91 | 1710973839 - SANJEEV JAIN | 371428941 - (WA) ALLERGY ASTHMA CENTER OF SW WASHINGTON LLC | WA | Allergy & Immunology Physician (207K00000X) |
United | 76872 | $105.16 | 1316056096 - SKOKOMISH TRIBAL COUNCIL, SKOKOMISH TRIBE HEALTH CENTER | 910874463 | WA | Multi-Specialty Group (193200000X) |
United | 76872 | $138.92 | 1710475199 - LAURA PASTERNACK | 954395492 | WA | Multi-Specialty Group (193200000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 76872 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76872 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 76872 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 |
|---|---|---|
| 76830-CPT | Low | Ultrasound Scan Of Uterus, Ovaries, Tubes, Cervix And Pelvic Area Through Vagina |
| 76831-CPT | Low | Saline Infusion Sonohysterography (Sis) Including Color Flow Doppler When Performed (Rvsd 1/1/04) |
| 76856-CPT | Low | Ultrasound, Pelvic (Nonobstetric), Real Time With Image Documentation; Complete |
| 76872-CPT | Moderate | Ultrasound Scan Of Pelvic Region Through Rectum |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76872. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76872 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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