Summary & Overview
CPT 76604: Ultrasound Evaluation of Pleural Spaces
CPT code 76604 denotes an ultrasound evaluation of the pleural spaces to identify fluid collections or masses in the chest, upper back, chest wall, or mediastinum. This imaging code is used across acute and ambulatory care settings to guide diagnosis and management of pleural effusion, suspected pleural mass, and related chest wall pathology. Nationally, pleural ultrasound is an important point-of-care and radiology service because it is rapid, radiation-free, and can influence urgent procedural decisions such as thoracentesis or further cross-sectional imaging.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clear description of the clinical service represented by the code, typical sites of service, and the common modifiers associated with billing for this type of diagnostic ultrasound. The publication also outlines benchmarking and reimbursement context, common payer policies affecting prior authorization and coverage, and clinical considerations relevant to billing and coding for pleural ultrasound. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 76604 describes an ultrasound evaluation of the pleural spaces to detect the presence of fluid or masses in the chest, upper back, chest wall, or mediastinum. This service typically involves real-time sonographic imaging to assess pleural effusions, pleural-based masses, or chest wall abnormalities.
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Service type: Diagnostic ultrasound evaluation of pleural spaces and adjacent chest structures
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Typical site of service: Hospital inpatient or outpatient imaging departments, emergency department, and other acute care settings where chest or pleural assessment is needed
Clinical & Coding Specifications
Clinical Context
A 68-year-old male presents to the emergency department with progressive shortness of breath, pleuritic chest pain, and hypoxia. Chest auscultation reveals diminished breath sounds at the left base. A chest radiograph suggests a possible pleural effusion. The emergency medicine physician orders point-of-care ultrasound of the thorax to evaluate the pleural spaces for fluid, pleural thickening, or masses and to guide potential diagnostic or therapeutic thoracentesis.
The clinical workflow: the provider (emergency physician, hospitalist, or pulmonologist) performs a focused thoracic ultrasound at bedside using a curvilinear or phased-array transducer, documents real-time images and interpretations in the medical record, and determines whether image-guided intervention (for example, thoracentesis) is indicated. Images and a written report are archived in the facility imaging system. If an invasive procedure is performed, separate procedure coding is considered in addition to the ultrasound evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When only the physician interpretation is billed separate from facility technical component |
TC |