CPT Code 76604: Under Diagnostic Ultrasound Procedures of the Chest

What is CPT code 76604?

CPT code 76604, as defined by the American Medical Association, refers to an ultrasound exam of the chest used to create images for evaluating pleural spaces, lung fields, and the mediastinum. Healthcare providers typically utilize this ultrasound service in settings such as emergency departments or intensive care units to diagnose and monitor conditions like pleural effusion, lung consolidation, mediastinal masses, or pericardial effusion. This ultrasound procedure, performed using an ultrasound machine, captures detailed images in real-time, enabling accurate diagnoses without the radiation exposure associated with a traditional chest X-ray. The 76604 CPT code covers both image documentation and professional interpretation, ensuring comprehensive assessment during a single procedural encounter.

What is a chest ultrasound?

A chest ultrasound is a diagnostic ultrasound exam used to create images of structures within the chest, including the lungs, pleural spaces, mediastinum, and chest wall. This non-invasive procedure helps identify conditions such as pleural effusions, pneumothorax, chest masses, or abnormal fluid collections. Chest ultrasound is particularly valuable in acute settings, such as the emergency department, where obtaining quick and detailed images is essential for making timely medical decisions.

CPT code 76604 documentation requirements

Accurate and detailed documentation is vital to support ultrasound billing compliance and justify the medical necessity of CPT 76604.

Clinical indication for the ultrasound

Clearly document the clinical indication prompting the ultrasound exam, such as shortness of breath, chest pain, suspected pleural effusion, or evaluation of mediastinal masses.

Areas evaluated

Document all specific anatomical regions assessed during the ultrasound service, including pleural spaces, lung fields, and mediastinum. Indicate clearly if evaluation extends to structures such as the inferior vena cava, if clinically indicated.

Real-time image acquisition and interpretation

Include explicit documentation that real-time ultrasound imaging was performed, including image documentation and interpretation findings, reflecting the diagnostic process accurately.

Radiologist’s or performing provider’s final impression

A detailed final impression from the interpreting radiologist or the same physician performing the ultrasound must be documented. This includes clear conclusions derived from the images obtained during the examination.

Confirmation of image storage

Explicitly confirm that images obtained during the ultrasound exam have been archived appropriately. This supports compliance and future patient care reference.

CPT code 76604 billing guidelines

Follow these guidelines to ensure appropriate reimbursement and compliance with payer requirements:

Report once per ultrasound exam session

CPT 76604 is billed only once per session, regardless of whether the exam involves unilateral or bilateral chest evaluations. Repeat procedures performed on the same patient during the same session are not separately billable unless distinctly justified.

Ultrasound guidance for procedures billed separately

Do not use 76604 for guidance on procedures such as thoracentesis. Instead, report ultrasound guidance separately using CPT 76942 when needle placement procedures are performed.

Component billing with modifiers

Use modifiers -26 (professional component) or -TC (technical component) as appropriate to distinguish between the professional interpretation and technical service provided.

Chest ultrasound specificity

Do not bill CPT 76604 as a limited extremity, abdominal aortic aneurysm screening, or other unrelated ultrasound service. Ensure the documentation clearly supports chest-specific ultrasound evaluations.

Related CPT codes

• 76942 – Ultrasound guidance for needle placement
• 93308 – Limited transthoracic echocardiogram (cardiac evaluation)
• 76705 – Limited abdominal ultrasound (e.g., diaphragm evaluation)
• 76641–76642 – Breast ultrasound procedures
• 76775 – Ultrasound retroperitoneal (includes evaluation of abdominal aortic aneurysm)