CPT 76942 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 76942 by major payers:
$80.73
$113.27
$122.93
$125.48
| 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 76942 | ||||||
United | 76942 | $52.40 | 1629385315 - NOSA AIGBE LEBARTY | 146002563 | NY | Hospitalist Physician (208M00000X) |
United | 76942 | $40.28 | 1457602344 - LORI ROLL | 540620889 - INOVA HEALTH CARE SERVICES | VA | Physical Therapist (225100000X) |
United | 76942 | $36.06 | 1386907053 - HELAI HESHAM | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Female Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician (207VF0040X) |
United | 76942 | $22.73 | 1427085109 - ATUL PRAKASH | 20635767 - (NJ) CARDIAC ARRHYTHMIA SPECIALIST PC | NJ | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 76942 | $85.65 | 1477669414 - CHRISTINA BASELGA | 540620889 - INOVA HEALTH CARE SERVICES | VA | Internal Medicine Physician (207R00000X) |
United | 76942 | $90.52 | 1508932864 - BETH BARRON | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Hospitalist Physician (208M00000X) |
United | 76942 | $22.20 | 1427085109 - ATUL PRAKASH | 20635767 - (NJ) CARDIAC ARRHYTHMIA SPECIALIST PC | NJ | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 76942 | $16.37 | 1760411433 - AZRIEL HAIMOWITZ | 1760411433 - (NY) AZRIEL HAIMOWITZ | NY | Cardiovascular Disease Physician (207RC0000X) |
United | 76942 | $22.86 | 1427085109 - ATUL PRAKASH | 20635767 - (NJ) CARDIAC ARRHYTHMIA SPECIALIST PC | NJ | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 76942 | $47.51 | 1689889511 - IMRAN AHMAD | 540620889 - INOVA HEALTH CARE SERVICES | VA | Hospitalist Physician (208M00000X) |
United | 76942 | $40.40 | 1932135662 - ALIREZA MALEKZADEH | 540620889 - INOVA HEALTH CARE SERVICES | VA | Orthopaedic Surgery Physician (207X00000X) |
United | 76942 | $29.65 | 1912074964 - RAHUL KUMAR | 20635767 - (NJ) CARDIAC ARRHYTHMIA SPECIALIST PC | NJ | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 76942 | $35.96 | 1609242080 - ERIN PAYNE | 540620889 - INOVA HEALTH CARE SERVICES | VA | Family Nurse Practitioner (363LF0000X) |
United | 76942 | $47.00 | 1386907053 - HELAI HESHAM | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Female Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician (207VF0040X) |
United | 76942 | $24.67 | 1043389869 - JOHN SMITH | 20635767 - (NJ) CARDIAC ARRHYTHMIA SPECIALIST PC | NJ | Cardiovascular Disease Physician (207RC0000X) |
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 76942 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76942 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 76942 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 |
|---|---|---|
| 76942-CPT | Low | Ultrasonic Guidance For Needle Placement (Eg, Biopsy, Aspiration, Injection, Localization Device), Imaging Supervision And Interpretation |
| 77002-CPT | Low | Fluoroscopic Guidance For Needle Placement (Eg Biopsy Aspiration Injection Localization Device) (List Separately In Addition To Code For Primary Procedure). (Desc Revised 1/1/2017) |
| 77011-CPT | Moderate | Computed Tomography Guidance For Sterotactic Localization |
| 77012-CPT | Low | Computed Tomography Guidance For Needle Placement (Eg Biopsy Aspiration Injection Localization Device) Radiological Supervision And Interpretation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76942. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76942 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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