Scrotal ultrasound (CPT 76870) Coverage Criteria
Defines medical necessity and coverage conditions for scrotal ultrasound (CPT 76870) for Cigna-administered health benefit plans and provides clinical background and guideline context for providers.
No material clinical or coverage changes in this revision.
Coverage Criteria for Scrotal Ultrasound (CPT 76870)
inv-01: Medically necessary indications
Scrotal ultrasound is considered medically necessary for an individual with ANY of the following indications:
Provider should document which indication applies
inv-02: Indications (per AIUM, AUA, NCCN)
Covered when indications from specialty guidelines or listed diagnoses are present
Derived from AIUM practice parameters and AUA/NCCN guidance.
inv-03: Cryptorchidism
Not routinely indicated in specific pediatric context
From AUA Evaluation and Treatment of Cryptorchidism guideline.
inv-04: Testicular microlithiasis
Screening and incidental findings
From AUA 2019 guideline.
inv-05: Suspicious testicular mass
Management of suspicious mass
From AUA testicular cancer guideline; MRI should not be used in initial evaluation.
Scrotal ultrasound is covered only for the indications listed as medically necessary. Per the policy, scrotal ultrasound is not covered or reimbursable for all other indications not listed as medically necessary (see the Medically Necessary Indications section for the full list such as acute scrotal pain, trauma, suspected infection, scrotal mass, varicocele, hydrocele, nonpalpable testes ≥ six months, infertility evaluation, and others).
The AUA guidance states that providers should NOT perform ultrasound or other imaging in the evaluation of boys with cryptorchidism prior to referral, because these studies rarely influence decision making; infants without spontaneous descent by six months should be referred to a surgical specialist. The policy notes that ultrasound in this context is not recommended and that services or codes identified as 'Not Covered or Reimbursable' may be excluded from payment per the plan.
During the annual review the policy authors documented no clinical policy statement changes. The review summary confirms that there were no modifications to coverage criteria or exclusions in the cited revision notes.
Multiple guideline reviews and primary society statements conclude that routine use of scrotal ultrasound for nonpalpable testes is not recommended because ultrasound does not add diagnostic accuracy (reported sensitivity ~45% and specificity ~78%) and does not reliably determine absence of a testis. Surgical referral after observation is the recommended approach rather than routine imaging.
The policy aligns with specialty guidance that routine scrotal ultrasound screening for testicular cancer in asymptomatic adolescent or adult men is not recommended. The USPSTF recommends against screening for testicular cancer in asymptomatic males, and the AUA guidance does not support routine screening with ultrasound in this population.
The document sections cited do not identify any additional specific conditions labeled explicitly as 'not medically necessary'; the annual review notes no changes to clinical policy statements and does not add new 'not medically necessary' listings in these chunks.
Coding
| 76870 | Ultrasound, scrotum and contents |
| 76870 | Ultrasound, scrotum and contents |
| C62.11 | Malignant neoplasm of descended testis |
| C62.12 | Malignant neoplasm of descended testis |
| C63.00 | Malignant neoplasm of epididymis |
| C63.02 | Malignant neoplasm of epididymis |
| C63.10 | Malignant neoplasm of spermatic cord |
| C63.12 | Malignant neoplasm of spermatic cord |
| C63.2 | Malignant neoplasm of scrotum |
| D29.21 | Benign neoplasm of right testis |
| D29.22 | Benign neoplasm of left testis |
| D29.30 | Benign neoplasm of unspecified epididymis |
| No codes listed |
Provider Actions, Documentation, and Authorization
Required documentation and clinical evaluation
Providers must document a supported diagnosis and clinical evaluation when requesting or billing for scrotal ultrasound (CPT 76870). Include a focused history and physical exam findings that justify imaging (for example acute scrotal pain, trauma, palpable mass, infertility evaluation, nonpalpable testis ≥ 6 months, suspected varicocele, hydrocele, or suspected inguinal hernia). Claims lacking documentation of a covered ICD-10 diagnosis from the policy's listed diagnoses may be denied as not covered.
- Affected CPT: 76870
- Require supporting ICD-10 diagnosis from policy (see considered medically necessary list: C62.*, C63.*, D29.*, D40.*, I86.1, K40.*, N43.*, N44.*, N45.*, N46.*, N49.*, N50.*, P83.5, Q53.*, Q55.*, S30.*, S31.*)
- Clinical evaluation: focused history and physical exam (standing and supine) expected prior to imaging
Prior authorization and coverage submission
When applicable, prior authorization or coverage requests for CPT 76870 should include the clinical rationale and supporting documentation that the service meets the medical necessity indications in this policy (for example acute testicular pain suspicious for torsion, palpable mass, or infertility evaluation with appropriate semen analysis findings). Services billed without a covered diagnosis or for indications not listed as medically necessary may be denied.
- Prior authorization context applies to CPT 76870 when required by the plan
- Document medical necessity by citing the specific listed ICD-10 diagnosis code and brief clinical justification
References to support clinical use
Scrotal ultrasound is considered medically necessary only for the indications listed in the Coverage Policy. Providers should reference the extensive evidence base and specialty guidance supporting these indications when making clinical decisions or preparing documentation. Key references include AIUM practice parameters, AUA guidelines (infertility, urotrauma, testicular cancer), NCCN testicular cancer guidelines, RSNA/RadiologyInfo resources, and multiple systematic reviews and imaging references.
- AIUM Practice Parameters (2011, 2021)
- AUA Guidelines (urotrauma, infertility, testicular cancer)
- NCCN Testicular Cancer Guidelines
- Selected literature: Kwee RM & Kwee TC 2018; Ota K et al. 2019; Schlegel PN et al. 2021; Radiol Clin North Am reviews
Background and Clinical Context
Ultrasound of the scrotum is a safe, noninvasive imaging modality that uses gray-scale and Doppler techniques to evaluate the testes and adjacent structures. It is commonly used for acute scrotal pain (including suspected torsion), trauma, palpable masses, varicocele assessment, hydrocele, localization of nonpalpable testes in select cases, infertility evaluation when the exam is limited, and follow-up of indeterminate findings.
Definitions
Revision History
Annual review completed with no clinical policy statement changes documented.
Annual review completed with no clinical policy statement changes documented.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.