Summary & Overview
CPT 76380: Focused Subsequent CT of a Specific Area
CPT code 76380 represents a focused, subsequent computed tomography (CT) scan restricted to a specific anatomic area used to reexamine patients when complications or tumor concerns arise. Nationally, this code matters because it captures targeted imaging services that inform acute clinical decisions—particularly in oncology, post-procedural follow-up, and complication assessment—affecting utilization, care pathways, and imaging resource allocation.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings, standard payer coverage considerations, common modifier usage (listed separately), and where CPT code 76380 fits among related imaging services. The brief outlines typical sites of service (outpatient imaging centers, hospital radiology departments, and ambulatory surgical centers) and clarifies that this is a noninvasive, region-specific CT intended for targeted reassessment rather than initial comprehensive imaging.
This summary provides practical benchmarking context and policy-relevant points for clinicians, billing professionals, and payers: how the code is used clinically, where it is billed, and what to expect in terms of overarching coverage patterns. Data not available in the input are noted in relevant sections.
Billing Code Overview
CPT code 76380 describes a subsequent computed tomography (CT) scan restricted to a specific area for focused reimaging or treatment assessment. This noninvasive imaging exam is performed when an ordering provider suspects complications, progression, or recurrence of a tumor and requires a targeted CT of a defined region rather than a comprehensive study.
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Service type: Focused CT reexamination
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Typical site of service: Outpatient imaging centers, hospital radiology departments, and ambulatory surgical centers
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of colorectal cancer presents with new onset abdominal pain and rising carcinoembryonic antigen (CEA). The treating oncologist orders a focused computed tomography (CT) of the abdomen and pelvis to evaluate a suspected local tumor recurrence or complication such as abscess or bowel obstruction. The patient arrives to an outpatient imaging center; registration confirms the order and relevant history, including prior imaging and contrast allergies. A CT technologist performs a limited CT study restricted to the area of clinical concern (for example, the lower abdomen and pelvis) rather than a full diagnostic CT of the chest, abdomen, and pelvis. Image acquisition parameters are set to target the suspected lesion, and intravenous contrast is administered when not contraindicated. Images are reconstructed and transmitted to the radiologist for interpretation. The radiologist documents findings, impression, and comparison to prior studies. Billing uses 76380 to report a subsequent CT limited to a specific area when the intent is targeted reexamination for suspected complication or tumor, and appropriate modifier(s) are appended as indicated by the encounter (for example, professional component modifier 26 when only interpretation is billed). Typical sites of service include outpatient imaging centers, hospital outpatient departments, and radiology suites in ambulatory surgical centers when clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|