Question:

The patient had a right breast ultrasound, and we billed CPT® code 76641 with modifier –RT. 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 such a case, you would not use modifier -RT or -LT, if you are performing only one side ultrasound. If you are performing bilateral breast ultrasound, then report the appropriate code with modifier -50.

CPT® is a registered trademark of the American Medical Association.

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CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

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.