Summary & Overview
CPT 76145: Medical Physicist Radiation Exposure Evaluation
CPT code 76145 reports a medical physicist’s evaluation and formal report assessing whether a patient’s radiation exposure exceeds an institution’s review threshold. This code captures an important safety and compliance activity tied to radiation-producing procedures and quality assurance in imaging and radiation therapy. Nationally, the code informs radiation safety program documentation and can affect institutional oversight and retrospective review processes.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise outline of the clinical context for the code, typical sites of service, and the types of administrative and clinical situations in which the code is used. The publication summarizes payer coverage considerations, common modifier usage provided in the input, and operational implications for billing and compliance.
The report also provides benchmarks and policy-relevant context where available, highlights areas where coding clarity affects radiation safety reporting, and identifies gaps in publicly available billing guidance. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 76145 describes a service in which a medical physicist evaluates and provides a report on radiation exposure to determine whether the exposure exceeds the institution's review threshold. The service type is a medical physics radiation exposure evaluation and reporting service. The typical site of service is hospital outpatient departments, radiology departments, or other healthcare facilities where radiation-producing procedures and radiation safety oversight occur.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient undergoing diagnostic or interventional procedures involving ionizing radiation (for example: computed tomography, interventional fluoroscopy, or nuclear medicine) is identified by radiation safety staff or clinical providers as having potentially exceeded institutional or regulatory exposure thresholds. Typical scenarios include a prolonged interventional fluoroscopy case with unexpected complexity, a CT protocol repeated multiple times during a single encounter, or a radiation therapy planning error that may have resulted in higher than intended exposure to staff or the patient. The clinical workflow begins with notification from the imaging or procedural team to radiation safety or medical physics. The medical physicist reviews exposure records, dosimetry reports, imaging system logs, and patient factors; calculates organ- or patient-specific dose estimates; compares results with institutional review thresholds and regulatory limits; documents findings; and generates a formal written report. The report may trigger root-cause analysis, patient and provider notification, corrective action, and documentation in the medical record or radiation safety file. For billing, the service is reported with 76145 when the medical physicist evaluates and provides a formal report determining whether exposure exceeds the institutional review threshold.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |