CPT 76965 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 76965 |
National average reimbursement for CPT 76965 by major payers:
$123.77
$145.08
$131.76
$168.29
| 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 76965 | ||||||
United | 76965 | $93.02 | 1326133042 - EDWARD TANG | 941754129 - (CA) PEDIATRIC ANESTHESIA ASSOCIATES MEDICAL GROUP, INC. | CA | Anesthesiology Physician (207L00000X) |
United | 76965 | $21.59 | 1407191984 - BSA HOSPITAL LLC | 900914340 | TX | General Acute Care Hospital (282N00000X) |
United | 76965 | $51.86 | 1285072538 - BRENDAN MUNZER | 381917674 - (MI) CHELSEA COMMUNITY HOSPITAL | MI | Emergency Medicine Physician (207P00000X) |
United | 76965 | $197.46 | 1962821991 - BERTHINA COLEMAN | 541581185 - MCV ASSOCIATED PHYSICIANS | WA | Diagnostic Radiology Physician (2085R0202X) |
United | 76965 | $43.43 | 1639564073 - DAVID DUNCAN | 310667480 - (OH) PROFESSIONAL RADIOLOGY, INC. | TX | Vascular & Interventional Radiology Physician (2085R0204X) |
United | 76965 | $129.21 | 1336142488 - SRINATH SUNDARARAMAN | 270484506 | FL | Radiation Oncology Physician (2085R0001X) |
United | 76965 | $43.43 | 1073813812 - ADITYA BAHEL | 310667480 - (OH) PROFESSIONAL RADIOLOGY, INC. | OH | Diagnostic Radiology Physician (2085R0202X) |
United | 76965 | $324.29 | 1932124997 - DANIEL KNIGHT | 390869788 - (WI) THEDACARE MEDICAL CENTER NEW LONDON INC | IL | Emergency Medicine Physician (207P00000X) |
United | 76965 | $73.98 | 1740934959 - JARED GROW | 201778316 | AZ | Acute Care Nurse Practitioner (363LA2100X) |
United | 76965 | $21.79 | 1205183415 - GRETHE MORTENSON | 861385436 | OR | Nurse Practitioner (363L00000X) |
United | 76965 | $309.64 | 1902845043 - NOEL TAN | 592013191 | FL | Neonatal-Perinatal Medicine Physician (2080N0001X) |
United | 76965 | $118.02 | 1780655795 - RALPH PICKARD | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | CO | Pediatric Radiology Physician (2085P0229X) |
United | 76965 | $43.43 | 1023061546 - JAMES CORNWELL | 310667480 - (OH) PROFESSIONAL RADIOLOGY, INC. | OH | Diagnostic Radiology Physician (2085R0202X) |
United | 76965 | $129.69 | 1952349714 - RAYMOND ROST | 310667480 - (OH) PROFESSIONAL RADIOLOGY, INC. | OH | Diagnostic Radiology Physician (2085R0202X) |
United | 76965 | $169.00 | 1124078563 - TEMPLE VAMC, WACO VAMC | 742791419 | TX | General Acute Care Hospital (282N00000X) |
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 76965 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76965 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 76965 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 |
|---|---|---|
| 76965-CPT | Low | Ultrasonic Guidance For Interstitial Radioelement Application |
| 76975-CPT | Low | Gastrointestinal Endoscopic Ultrasound, Radiological Supervision & Int |
| 76977-CPT | Low | Ultrasound Bone Density Measurement And Interpretation Peripheral Site(S) Any Method |
| 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) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76965. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76965 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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