Radiology Question for the Week of May 12, 2025

Question:

Can you provide any additional tips or coding examples for modifier 76?

Answer:

Modifier 76 may be required in certain settings or for certain procedures by specific payers. Some payers may require modifier 76 to be reported in lieu of modifier 59 or one of the X{EPSU} modifiers. Mammography procedures performed on outpatients are reimbursed (assuming they are Medicare patients) under the Medicare Physician Fee Schedule. They have a status indicator of “A” under the OPPS. Coding Example (for some payers): A patient presents for cyst aspiration of multiple cysts (3) within the right breast. The aspirations are performed under ultrasound guidance. To report this aspiration procedure, report CPT® code 19000 (puncture aspiration of cyst of breast) for the initial cyst aspiration with modifier RT appended. CPT code +19001, puncture aspiration of cyst of breast; each additional cyst (list separately in addition to code for primary procedure), describes the aspirations of the second and third cysts. Report CPT code +19001 twice. Some third-party payers may require that you report it once with modifier RT and once with modifier 76 and RT (i.e., +19001-RT and +19001-76-RT). As always, check with your specific payer for direction on this.

This question was answered in our Breast & Bone Density Procedure Coding Guide. For more hot topics relating to radiology services, please visit our store or call us at 1.800.252.1578, ext. 2.