Summary & Overview
CPT 91200: Liver Elastography for Lesion Characterization
CPT code 91200 captures elastography-based imaging used to evaluate liver lesions by measuring tissue elasticity to distinguish benign from malignant tumors and differentiate lesions from normal parenchyma. Nationally, utilization of elastography is important as noninvasive lesion characterization can reduce unnecessary biopsies and guide follow-up imaging or treatment planning.
This analysis covers major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for CPT code 91200, common sites of service and service type, and what payers typically consider when reimbursing elastography procedures. The publication provides benchmarking context where available, describes coding and billing considerations, and outlines policy and coverage themes relevant to diagnostic liver elastography.
Intended for clinical administrators, coding professionals, and policy analysts, the summary highlights where elastography fits into diagnostic pathways for liver lesions and which payer policies and reimbursement practices influence access to this noninvasive imaging option. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 91200 describes the use of elastography to evaluate liver lesions, assessing tissue elasticity to help distinguish benign (more elastic) from malignant (less elastic) tumors and to differentiate lesions from surrounding normal liver tissue. The technique quantifies tissue stiffness, aiding clinical decision-making about lesion characterization.
Service type: Diagnostic imaging with elastography
Typical site of service: Hospital outpatient imaging department or freestanding radiology/ultrasound clinic
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of chronic hepatitis B presents after surveillance ultrasound detected a 2.5 cm focal liver lesion. The hepatologist orders elastography to characterize the lesion’s stiffness and distinguish benign from malignant pathology as part of noninvasive evaluation. The procedure is performed in an outpatient imaging center or hospital radiology department by a credentialed physician (radiologist or hepatologist) or sonographer under physician supervision. The workflow includes patient consent, focused hepatic ultrasound with elastography measurements, documentation of shear-wave or transient elastography values, comparison with prior imaging if available, and a written report describing elastography findings, B-mode morphology, and recommended correlation with MRI, biopsy, or clinical follow-up as indicated. The technical component may be billed by the facility and the professional component by the interpreting physician when applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation for the elastography study. |
TC | Technical component |