CPT Code 76870: Ultrasound Examination of Scrotum and Contents

Key Takeaways

CPT 76870 describes diagnostic ultrasound of scrotum and contents

Used for testicular mass, epididymitis, hydrocele, and varicocele evaluation

Requires complete real-time imaging with permanent image documentation

Medicare national payment averages $89-124 depending on setting

Bundling rules apply when performed with other genitourinary imaging

Introduction to CPT Code 76870

CPT code 76870 describes a complete ultrasound examination of the scrotum and its contents, a non-invasive diagnostic imaging procedure that helps clinicians evaluate testicular and scrotal pathology. Radiology and urology practices use this code when ordering scrotal ultrasound to investigate conditions such as testicular mass, epididymitis, hydrocele, varicocele, or suspected testicular torsion.

This billing guide covers clinical indications, documentation requirements, modifier usage, reimbursement rates, and coding scenarios for CPT code 76870. Understanding proper billing practices helps radiology departments and urology clinics optimise revenue capture while maintaining compliance with payer requirements.

What is CPT Code 76870?

According to the American Medical Association CPT code set, CPT 76870 falls under the Diagnostic Ultrasound Procedures of the Genitalia category. The code represents a complete ultrasound examination that includes real-time scanning of both the scrotum and its contents with image documentation.

The procedure uses high-frequency sound waves to create detailed images of the testicles, epididymis, spermatic cord, and scrotal wall. Healthcare providers use this ultrasound of the scrotum and contents to assess conditions like pain, swelling, or masses.

Radiologists or sonographers perform the examination with the patient typically in a supine position, using a high-frequency linear transducer to capture both grey-scale and colour Doppler images when vascular assessment is clinically indicated.

CPT Code 76870 Technical Components

A complete scrotal ultrasound under CPT code 76870 must document bilateral examination of both testicles and surrounding structures. This specific ultrasound procedure focused on testes provides valuable insights into structural and functional status.

The examination includes assessment of testicular echotexture, measurement of testicular dimensions, evaluation of the epididymis bilaterally, and visualisation of any fluid collections or masses. Colour Doppler imaging may be performed to assess testicular blood flow, particularly when evaluating suspected torsion or inflammatory conditions.

The Centers for Medicare & Medicaid Services Physician Fee Schedule assigns work relative value units (wRVUs) of 0.95 for CPT 76870, reflecting the technical skill and physician interpretation required. Documentation must include a written report with measurements, descriptions of any pathology, and comparison to previous imaging when available.

CPT Code 76870 Clinical Indications and Documentation

Payers require medical necessity documentation before authorising reimbursement for CPT code 76870. This non-invasive imaging procedure for scrotum uses high-frequency sound waves to create images of testicular structures.

Clinicians must document clinical findings that justify the examination, such as palpable testicular mass, scrotal pain, scrotal swelling, or abnormal physical examination findings. Prior authorisation requirements vary by payer, with some commercial insurers requiring pre-approval while Medicare typically does not for diagnostic imaging ordered by qualified practitioners.

CPT Code 76870 Common Clinical Scenarios

Testicular mass evaluation represents the most common indication for CPT code 76870. When a clinician palpates a suspected mass during physical examination, ultrasound helps differentiate between solid and cystic lesions, assess whether masses are intratesticular or extratesticular, and guide further management decisions. Documentation must specify the location, size, and characteristics of any identified mass.

Acute scrotal pain requires rapid diagnostic imaging to rule out testicular torsion, a surgical emergency. CPT 76870 includes colour Doppler assessment of testicular blood flow, which helps differentiate torsion from inflammatory conditions like epididymitis or orchitis. Claims for emergency department scrotal ultrasound typically pair with ICD-10 codes for acute scrotal pain (N50.8) or testicular torsion (N44.0).

Hydrocele and varicocele assessment commonly use CPT code 76870 for initial evaluation and post-treatment follow-up. Ultrasound quantifies fluid volume in hydroceles and assesses venous dilation in varicoceles, particularly when physical examination findings are equivocal. Measurements tracking software helps radiology departments maintain consistent measurement protocols across examiners.

CPT Code 76870 Documentation Requirements

Complete documentation for CPT code 76870 must include bilateral testicular measurements in three dimensions (length, width, anteroposterior diameter), description of testicular echotexture and vascularity, epididymal appearance bilaterally, presence and characterisation of any masses or fluid collections, and Doppler assessment findings when performed. The written report must specify the clinical indication and address the referring provider’s specific diagnostic question.

Permanent images must be stored in the facility’s picture archiving and communication system (PACS). The CMS HCPCS coding system requires retention of representative images demonstrating each testicle in multiple planes, any identified pathology, and Doppler waveforms when vascular assessment was performed. Practices using integrated clinical record systems can link ultrasound reports directly to patient encounters for streamlined documentation workflows.

CPT Code 76870 Reimbursement Rates and Fee Schedules

Medicare reimbursement for CPT code 76870 varies by setting and geographic locality. The table above shows 2026 national payment amounts before geographic adjustment. Actual payments reflect the Medicare Physician Fee Schedule locality-specific conversion factor multiplied by the total RVUs for the service. Non-facility settings receive higher practice expense (PE) RVUs because they bear equipment and overhead costs, while hospital outpatient departments receive lower facility PE rates.

Commercial payer rates typically range from 120% to 250% of Medicare rates depending on contract negotiations. Radiology practices should verify contracted rates annually and appeal underpayments when claims process below contracted amounts. The CMS list of CPT/HCPCS codes provides annual updates to reimbursement values that affect financial forecasting for imaging departments.

CPT Code 76870 Professional vs Technical Component Billing

CPT code 76870 includes both professional and technical components. When a facility owns the equipment and employs the sonographer, but an external radiologist interprets the images, practices must split-bill using modifier 26 (professional component) for the radiologist’s interpretation and modifier TC (technical component) for the facility’s equipment and technical staff costs.

Global billing using CPT code 76870 without modifiers applies when one entity provides both the technical performance and professional interpretation. When billed with procedures like prostate biopsy or duplex ultrasound, ensure distinct anatomical regions are documented.

Most radiology groups employ this approach in freestanding imaging centres. Hospital-based radiologists typically bill only the professional component (76870-26) while the hospital bills the technical component (76870-TC) separately. Understanding this split helps practices maximise reimbursement by ensuring each entity bills their appropriate component.

CPT Code 76870 Modifiers and Bundling Rules

Modifier usage affects CPT code 76870 reimbursement and compliance. The most common modifiers for scrotal ultrasound include modifier 26 for professional component only, modifier TC for technical component only, and modifier 76 for repeat procedures performed on the same day by the same physician. Bilateral procedures do not require modifier 50 because the code descriptor inherently includes bilateral examination.

CPT Code 76870 with 76882: Bilateral Inguinal Hernia Evaluation

When ordering scrotal ultrasound with bilateral inguinal hernia evaluation, practices must report both CPT 76870 and CPT 76882. According to Bracco Reimbursement coding guidance, the appropriate code combination is 76870 with 76882 x 2 (or 76882-50, or 76882-LT and 76882-RT, depending on payer preference). This bundling scenario commonly occurs when evaluating indirect inguinal hernias that may extend into the scrotum.

Payers review these combinations for medical necessity, so documentation must clearly indicate separate clinical indications for each examination component. The scrotal ultrasound addresses intrascrotal pathology while the inguinal ultrasound evaluates hernia presence, reducibility, and contents. Claims management software should flag this combination for documentation review before submission to prevent denials for lack of medical necessity.

National Correct Coding Initiative (NCCI) Edits for CPT Code 76870

The National Correct Coding Initiative (NCCI) publishes quarterly updates to code pair edits that prevent inappropriate bundling. CPT code 76870 has several column 2 codes that should not be billed separately on the same date of service unless modifier 59 or XU documentation supports distinct anatomical sites or separate patient encounters. Common NCCI edits include bundling of limited scrotal ultrasound codes when performed during the same session as a complete examination.

Practices must verify current NCCI edits before billing multiple imaging codes on the same claim. The AMA CPT coding resources provide quarterly NCCI edit updates that affect ultrasound coding compliance. Claims management software with built-in NCCI edit checks prevents submission of inappropriately bundled codes before claims reach the clearinghouse.

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Common Denial Reasons and Appeals for CPT Code 76870

Medical necessity denials represent the most frequent reason for CPT code 76870 claim rejections. Payers often deny scrotal ultrasound claims when documentation does not clearly establish clinical indications or when ordering without appropriate preliminary physical examination. Appeals should include the ordering provider’s clinical notes documenting physical examination findings, relevant patient symptoms, and the diagnostic question the ultrasound addresses.

Insufficient Documentation Denials for CPT Code 76870

Payers reject claims when the ultrasound report fails to document required elements. Missing bilateral testicular measurements, absent description of normal structures, or failure to address the clinical indication listed on the order all trigger denials for insufficient documentation. The appeal process requires submission of the complete ultrasound report demonstrating all required elements were performed and documented, even if initially omitted from the claim submission.

Some payers implement frequency limits for CPT code 76870, denying claims when repeat examinations occur within specified timeframes without documented interval clinical change. Medicare does not impose frequency limits for diagnostic ultrasound, but some Medicare Advantage plans and commercial payers restrict repeat scrotal ultrasound to once per 90 or 180 days. Appeals should document new symptoms, clinical change, or post-treatment follow-up that justifies repeat imaging sooner than payer frequency policies allow.

Bundling denials occur when payers incorrectly combine CPT code 76870 with other imaging codes performed on the same date. Review the explanation of benefits carefully to identify whether the denial stems from an NCCI edit (legitimate bundling) or from payer-specific edits that contradict Medicare policy. For non-Medicare payers, appeals should reference Medicare’s payment policy as supporting documentation when payer edits differ from NCCI rules. Practices using automated workflow software can flag unusual denial patterns for systematic appeal tracking.

Prior Authorisation Requirements for CPT Code 76870

Commercial payer prior authorisation requirements for CPT code 76870 vary significantly. Some insurers require pre-approval for all diagnostic ultrasound studies, while others exempt scrotal ultrasound from prior authorisation requirements. Radiology practices should maintain a current matrix of payer-specific authorisation policies to prevent avoidable denials.

When prior authorisation is required but not obtained, payers typically deny the entire claim rather than processing at a reduced rate. These denials are often non-appealable because the provider failed to follow payer policy. Front-office staff must verify authorisation requirements before scheduling scrotal ultrasound examinations. Some patient scheduling systems integrate real-time eligibility verification tools that check prior authorisation requirements during the booking process.

CPT Code 76870 Coding Scenarios and Examples

Practical coding scenarios help radiology billing staff apply CPT code 76870 correctly across different clinical situations. Each scenario below demonstrates proper code selection, modifier usage, and documentation requirements.

Scenario 1: Routine Scrotal Ultrasound for Palpable Mass

A 32-year-old male presents to urology with a palpable left testicular mass discovered during self-examination. The urologist orders complete scrotal ultrasound to characterise the mass. The radiology department performs bilateral scrotal ultrasound with measurements of both testicles, colour Doppler assessment of the left testicular mass showing internal vascularity, and documentation of normal right testicular architecture.

Correct billing: CPT code 76870 (global, no modifiers needed). Link to ICD-10 code N50.8 (other specified disorders of male genital organs). Medicare reimburses $123.67 in non-facility settings. The bilateral examination is inherent to the code descriptor, so modifier 50 should not be appended even though both testicles were examined.

Scenario 2: Emergency Department Scrotal Pain with Doppler Assessment

A 16-year-old male presents to the emergency department with acute onset severe left scrotal pain and swelling. The emergency physician orders urgent scrotal ultrasound to rule out testicular torsion. The ultrasound demonstrates decreased colour Doppler flow to the left testicle compared to the right, with heterogeneous left testicular echotexture.

Correct billing: CPT code 76870 (facility technical component only, modifier TC) by the hospital. The interpreting radiologist bills CPT code 76870-26 (professional component). Link to ICD-10 code N44.0 (torsion of testis). The colour Doppler assessment is included in the base code and should not be billed separately. Emergency department scrotal ultrasound does not require prior authorisation even when payers normally require pre-approval for outpatient diagnostic imaging.

Scenario 3: Follow-up Scrotal Ultrasound Post-Orchiectomy

A 45-year-old male with history of right orchiectomy for testicular cancer six months prior returns for surveillance imaging. The oncologist orders scrotal ultrasound to assess the remaining left testicle and evaluate the surgical bed for recurrence. The ultrasound shows normal left testicular architecture with no masses, and no evidence of recurrence in the right hemiscrotum.

Correct billing: CPT code 76870 despite unilateral testicle. The code describes examination of “scrotum and contents,” which includes bilateral hemiscrotum evaluation even when only one testicle remains. Link to ICD-10 code Z85.49 (personal history of malignant neoplasm of other male genital organs). Do not use modifier 52 (reduced services) because the examination includes assessment of both sides of the scrotum per the ordering provider’s request. Documentation should specify post-orchiectomy status and note evaluation of both hemiscrota.

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Conclusion

CPT code 76870 billing requires understanding of clinical indications, complete documentation requirements, modifier usage, and payer-specific rules. Radiology practices that standardise documentation protocols, verify prior authorisation requirements, and systematically appeal denials achieve higher reimbursement rates and fewer compliance risks.

Accurate coding for scrotal ultrasound examinations depends on clear communication between ordering providers, sonographers, and interpreting radiologists. Practices should implement quarterly coding audits to identify documentation gaps, review denial patterns, and update billing protocols based on evolving payer policies. Integrated practice management systems streamline these workflows by linking clinical documentation directly to billing codes and automating compliance checks before claim submission.

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