CPT 76999 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 59 - Distinct Procedural Service • 26 - Professional component |
| Complexity Level | High |
National average reimbursement for CPT 76999 by major payers:
$1,008.41
$58.37
$201.36
$501.31
| 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 76999 | ||||||
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CPT 76999 vs. Other Diagnostic Ultrasound Procedures Codes
The CPT 76999 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 76999 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 |
|---|---|---|
| 76885 | Low | Ultrasound Infant Hips Real Time With Imaging Documentation; Dynamic (Requiring Physician Or Otherqualified Health Care Professional Manipulation) (Revised 1/1/2013) |
| 76886 | Low | Ultrasound Infant Hips Real Time With Imaging Documentation; Limited Static (Not Requiring Phy- Sician Or Other Qualified Health Care Professionalmanipulation) (Revised 1/1/2013) |
| 76999 | High | Unlisted Ultrasound Procedure |
| 77001 | Low | Fluoroscopic Guidance For Central Venous Access Device Placement Replacement (Catheter Only Or Complete) Or Removal (Includes Fluoroscopic Guidance For Vascular Access And Catheter Manipulation Any Necessary Contrast Injections Through Access Site Or Catheter With Related Venography Radiologic Supervision And Interpretation And Radiographic Documentation Of Final Catheter Position) (List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76999. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76999 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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
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