Back to Top Skip to main content

Health.mil: the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

TRICARE Policy Manual 6010.60-M, April 1, 2015
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.
- END -

Utility Navigation Links

DoD Seal

tricare.mil is the offical website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Help Resources page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.

v4.5.7082.22297

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.