Question:

The patient had a right breast ultrasound, and we billed the following CPT® code with
modifier -RT:

76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete

The insurer denied this claim due to the modifier. Doesn’t the breast ultrasound require a modifier?

Answer:

Unfortunately, modifier use is payer-specific. Each payer makes its own rules about how it wants modifiers assigned. In the case you describe above, since the payer is denying because of the modifier, you would not use modifier -RT or -LT, if you are performing a unilateral ultrasound.  Remember, if billing for the interpretation only, you must include modifier -26.

If you are performing bilateral breast ultrasound, then report the appropriate code with modifier  -50. However, note that some providers still believe that modifier 50 should not be used for radiology claims (according to previous guidance from the American Medical Association), but that has changed over the last several years. It is now a required modifier for some radiology procedures and some payers. As stated above, modifiers are payer-specific and in many cases if you want to get bilateral radiology procedures paid, you must use modifier -50.


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This question was answered in an edition of our Radiology Compliance Manager. For more hot topics relating to radiology services, please view our store, or call us at 1.800.252.1578 ext. 2.

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.