Summary & Overview
CPT 76641: Complete Diagnostic Ultrasound of One Breast
CPT code 76641 represents a complete diagnostic ultrasound examination of one breast, including documentation of imaging. This code is used nationally to report comprehensive unilateral breast ultrasound studies performed for evaluation of breast symptoms, focal findings on other imaging, or surveillance in clinical contexts where ultrasound is indicated. Accurate reporting of 76641 supports appropriate clinical communication and claims processing for breast imaging services.
Analysis covers major national payers and public programs: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how coverage and payment may vary across payers, common billing considerations, and performance benchmarks where available.
Readers will learn: the clinical scope of the code and typical sites of service; payer coverage landscape and billing practices; typical modifiers and coding considerations (listed separately); and practical context for interpreting utilization and reimbursement trends. Where specific data elements were not provided in the input, the text notes that those elements are not available. The focus is national policy and billing context rather than provider recommendations.
Billing Code Overview
CPT code 76641 describes a complete ultrasound of one breast with documented imaging. The procedure includes acquisition and formal documentation of diagnostic images for a single breast and is intended for diagnostic evaluation of breast tissue.
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Service type: Diagnostic breast ultrasound (single breast complete study)
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Typical site of service: Outpatient imaging centers, hospital outpatient departments, and physician offices where diagnostic ultrasound is performed
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman aged 35–70 presenting to a breast imaging clinic or hospital radiology department for evaluation of a palpable lump, focal breast pain, or an abnormal screening mammogram. The clinician orders a diagnostic breast ultrasound of one breast when targeted imaging is needed to characterize a palpable abnormality, an area of mammographic asymmetry, or to guide decision-making between surveillance and biopsy. The workflow: patient registration and consent; review of indication and prior imaging; targeted ultrasound performed by a sonographer or radiologist using high-frequency transducer; acquisition of real-time grayscale and Doppler images of the entire affected breast region; documentation of representative images and measurements; interpretation by a credentialed radiologist; generation of a formal report with BI-RADS assessment and recommendations; communication of urgent findings to the ordering provider and arrangement for biopsy if indicated. Typical site of service is an outpatient imaging center, hospital outpatient radiology department, or diagnostic breast clinic.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the interpretation by the physician separate from technical work |
TC |