Summary & Overview

CPT 76642: Focused Limited Ultrasound of One Breast

CPT code 76642 represents a focused, limited ultrasound examination of one breast with image documentation. This targeted imaging service is used to evaluate a localized area of concern—such as a palpable lump or a mammographic abnormality—when a full bilateral or complete diagnostic breast ultrasound is not required. Nationally, focused breast ultrasound is an important tool in the diagnostic pathway for breast symptoms because it is widely available, relatively low cost, and often used as the next-step imaging modality following screening or clinical findings.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 76642, common billing and documentation elements, and where this service typically occurs (outpatient radiology or breast imaging centers). The publication also outlines benchmarking considerations and recent policy or coverage trends relevant to focused breast ultrasound services. Intended for payers, billing professionals, and clinical administrators, the content clarifies what the code denotes and what to expect in national coverage and billing practice. Data not available in the input will be indicated where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare76642CPTbreast ultrasounddiagnostic imagingradiologyfocused ultrasoundoutpatient imagingbreast imagingmedical billing

Billing Code Overview

CPT code 76642 describes a focused ultrasound examination of a single breast limited to a specific area. The procedure includes acquisition and documentation of ultrasound images for the targeted portion of one breast, typically performed when a localized finding on physical exam or imaging (such as mammography) requires sonographic evaluation.

Service type: Diagnostic imaging (focused breast ultrasound)
Typical site of service: Outpatient radiology suite, breast imaging center, or office-based imaging setting

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old woman presents to an outpatient breast imaging clinic with a palpable focal lump in the upper outer quadrant of the right breast. Physical exam localizes a 1.5 cm tender nodule. The provider orders a targeted diagnostic breast ultrasound to evaluate the palpable abnormality. The focused ultrasound of one breast (limited, targeted area) is performed by a diagnostic radiologist or breast imaging sonographer under radiologist supervision. The study includes acquisition and documentation of representative still images and cine clips of the lesion in two orthogonal planes, measurement of lesion size, assessment of margins and internal characteristics, and evaluation for associated vascularity or axillary lymphadenopathy as indicated. Results are documented in the patient’s electronic medical record with an impression that guides subsequent management (short-term imaging follow-up, ultrasound-guided biopsy, or referral to surgery). Typical sites of service include outpatient imaging centers, hospital outpatient departments, and radiology suites within ambulatory clinics. The service is limited to one breast and to a focused anatomic area corresponding to the clinical problem.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Used when reporting only the physician interpretation and report for the ultrasound if technical component billed separately by facility.

Taxonomy Code	Specialty	Notes
2086S0001X	Diagnostic Radiology	Primary specialty performing breast ultrasound interpretation and procedures.
207RC0000X	Radiologic Technologist	Sonographers and technologists performing image acquisition under supervision.
363L00000X	Obstetrics & Gynecology	OB/GYNs may perform point-of-care breast ultrasound in clinic settings for focused evaluations.

ICD-10 Code	Description	Clinical Relevance
`R92.8`	Other abnormal and inconclusive findings on diagnostic imaging of breast	Commonly used when imaging shows an abnormality requiring targeted ultrasound.
`N63`	Unspecified lump in breast	Typical presenting symptom prompting a focused limited breast ultrasound.
`N64.4`	Mastodynia	Focal breast pain that may prompt a limited ultrasound to exclude an underlying lesion.
`N60.2`	Fibrosclerosis of breast	Benign breast change often evaluated with targeted ultrasound for focal masses.
`C50.919`	Malignant neoplasm of unspecified site of right female breast	Used when ultrasound evaluates a known or suspected breast malignancy focal area.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`76641`	Ultrasound, breast, unilateral, real time with image documentation, complete	Used when a full diagnostic survey of the entire breast is performed rather than a focused limited exam; more comprehensive than `76642`.
`76642`	Ultrasound, breast, unilateral, real time with image documentation, limited	The focused unilateral limited ultrasound procedure described; used for targeted evaluation of a specific palpable abnormality or symptom.
`77022`	Radiological guidance for needle placement (e.g., biopsy), imaging supervision and interpretation	Performed when ultrasound guidance is required for breast biopsy following abnormal focused ultrasound findings.
`76942`	Ultrasonic guidance for needle placement (e.g., for aspiration, biopsy)	Used when real-time ultrasound guidance is provided during percutaneous procedures following the diagnostic ultrasound.
`19083`	Biopsy, breast, with placement of marker, percutaneous, single lesion, stereotactic or ultrasound guidance	Performed when the focused ultrasound leads to image-guided percutaneous core biopsy and marker placement.

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