CPT 76536: Ultrasound, Soft Tissues of Head and Neck
Medicare pays $75 and commercial payers pay $187 on average nationally for this procedure.
CPT code 76536 describes a real-time diagnostic ultrasound examination of the soft tissues of the head and neck with images recorded and saved for later review; the service is an ultrasound imaging study typically performed in an outpatient clinic, radiology department, or office-based setting for evaluation of thyroid nodules, neck masses, lymph nodes, and other superficial head and neck soft-tissue abnormalities.
For related coverage guidance, see recent payer policy updates: Office-based Laryngeal Procedures, Injectable Dermal Fillers and Bulking Agents (for New Mexico Only), Injectable Dermal Fillers and Bulking Agents (for Kentucky Only).
Customize your policy alerts
Sign up for cpt 76536 policy alerts
Get alerted when payer policies referencing 76536 are released or updated.
Monitor payer policy activity
National Reimbursement Benchmarks
Medicare’s mean rate of $75.4 sits well below BUCA’s mean commercial rate of $186.6, indicating a substantial gap between the federal program and this commercial benchmark: BUCA’s average is roughly $111.2 higher than Medicare. That gap highlights different valuation levels for CPT 76536 between a major commercial aggregator and the Medicare fee level.
Examining dispersion using the interquartile range (P75–P25), Blue Cross Blue Shield has a range of $83.3 (P75 $289.9 − P25 $201.6) and BUCA’s IQR is $87.8 (P75 $224.6 − P25 $136.8), which are among the wider spreads. Aetna’s IQR is $69.0, Cigna’s is $101.6, and UnitedHealth Group’s is $85.5; Cigna shows the widest 25–75 spread while Aetna is the tightest of these payers.