Radiology
Chapter 5
Section 2.1
Diagnostic
Ultrasound
Issue Date: November 1, 1983
Copyright: CPT only © 2006 American Medical
Association (or such other date of publication of CPT).
All Rights Reserved.
Revision:
1.0 CPT PROCEDURE CODE RANGES
Diagnostic Ultrasound: 76506
- 76776, 76800 - 76886
Ultrasonic Guidance: 76930
- 76965
Ultrasound
Other: 76970 - 76999
2.0 DESCRIPTION
The visualization of deep structures
of the body by recording the reflections (echoes) of pulses of ultrasonic
waves direct into the tissues. Ultrasound is used for diagnostic
and guidance purposes.
3.0 POLICY
3.1 Ultrasound
procedures for diagnosis, guidance, and post-operative evaluation
of surgical procedures may be cost-shared.
3.2 Maternity
related ultrasound. Professional and technical components of medically
necessary fetal ultrasounds are covered outside the maternity global
fee. The medically necessary indications include (but are not limited
to) clinical circumstances that require obstetric ultrasounds to:
estimate gestational age, evaluate fetal growth, conduct a biophysical
evaluation for fetal well being, evaluate a suspected ectopic pregnancy,
define the cause of vaginal bleeding, diagnose or evaluate multiple gestations,
confirm cardiac activity, evaluate maternal pelvic masses or uterine
abnormalities, evaluate suspected hydatidiform mole, and evaluate
the fetus’ condition in late registrants for prenatal care.
3.3 Bone Density studies (Current
Procedural Terminology (CPT) procedure code 76977) are covered for:
3.3.1 The diagnosis and monitoring
of osteoporosis.
3.3.2 For the
diagnosis and monitoring of osteopenia.
3.3.3 Patients
must present with signs and symptoms of bone disease or be considered
at high-risk for developing osteoporosis. High-risk factors for
osteoporosis are those identified as the standard of care by the
American College of Obstetricians and Gynecologists (ACOG).
4.0 EXCLUSIONS
4.1 Ultrasound
for routine screening for breast disease.
4.2 Ultrasound
performed solely to determine the sex of an unborn child for non-medical
reasons.
4.3 Bone density studies for routine
screening for osteoporosis.
4.4 Ultrasound,
spinal canal and contents (CPT procedure code 76800) for spinal
scanning in adults for inflammatory conditions of the spine and
nerve roots or as guidance for facet joint or epidural injections
(CPT procedure codes 76881 and 76942).
4.5 3D and
4D rendering (CPT procedure codes 76376 and 76377) with maternity
ultrasound is unproven.
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