{"id":154562,"date":"2026-07-15T11:33:36","date_gmt":"2026-07-15T11:33:36","guid":{"rendered":"https:\/\/pabau.com\/?p=154562"},"modified":"2026-08-13T12:05:27","modified_gmt":"2026-08-13T12:05:27","slug":"cpt-code-91200","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-91200\/","title":{"rendered":"CPT Code 91200: Liver elastography billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 91200: Liver Elastography Billing Guide\",\"description\":\"Complete billing reference for CPT Code 91200 (liver elastography \/ FibroScan). Covers modifiers, ICD-10 pairings, 2026 Medicare rates, documentation, and denial prevention.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-91200\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-08\",\"dateModified\":\"2026-07-15\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key Takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key Takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT Code 91200 describes liver elastography (VCTE\/FibroScan) without imaging guidance, used to assess hepatic fibrosis stage noninvasively.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Modifier TC (technical component) or modifier 26 (professional component) must be applied when the procedure is split across providers or facilities.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Missing or mismatched ICD-10 codes are the leading denial reason for CPT Code 91200 claims; K74.60, K76.0, and B18.2 are among the most commonly accepted pairings.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pabau&#8217;s claims management software helps gastroenterology and hepatology practices automate modifier selection, ICD-10 pairing, and pre-submission claim scrubbing for codes like 91200.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">Claim denials for CPT Code 91200 almost always come down to the same handful of mistakes: wrong modifier, missing ICD-10 linkage, or documentation that payers flag as lacking medical necessity. For gastroenterology and hepatology practices billing liver elastography, these errors add up fast.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The 2026 Medicare national average reimbursement for CPT Code 91200 is approximately $33.73 for the global service, calculated from the code&#8217;s 1.01 total RVUs multiplied by the 2026 Medicare conversion factor of $33.4009, before geographic adjustments. Accurate first-pass submission is critical to protecting that revenue.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\">\n<div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div>\n<\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This reference covers everything billers and coders need to submit CPT Code 91200 correctly: the official procedure description, applicable modifiers, accepted ICD-10 pairings, 2026 Medicare rates, commercial payer coverage criteria, documentation requirements, and the most common denial reasons with prevention strategies.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">CPT Code 91200: Definition and clinical description<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code structure and categories are maintained by the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association (AMA)<\/a>, which defines CPT Code 91200 as: <strong>Liver elastography, mechanically induced shear wave (e.g., vibration), without imaging, with interpretation and report.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In plain terms, this code covers noninvasive liver stiffness measurement using vibration-controlled transient elastography (VCTE). The FibroScan device by Echosens is the dominant platform used in clinical practice, though the code is technology-neutral under AMA guidelines. CPT Code 91200 sits within the Gastroenterology section of the CPT code set.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">91200<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official description<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Liver elastography, mechanically induced shear wave (e.g., vibration), without imaging, with interpretation and report<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Gastroenterology (CPT 91010-91299)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Technology<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Vibration-controlled transient elastography (VCTE); FibroScan is the primary device<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Imaging guidance required<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No (distinguishes from CPT 76981)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical setting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Gastroenterology \/ hepatology office (POS 11) or outpatient hospital (POS 22)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 class=\"wp-block-heading\">Procedure description: How liver elastography works<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">VCTE uses a probe placed on the skin over the liver. The device delivers a small mechanical vibration, then measures how quickly a shear wave travels through liver tissue. Stiffer tissue, indicating greater fibrosis, transmits the wave faster. Results are expressed in kilopascals (kPa) and mapped against validated fibrosis staging scales (F0-F4).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The procedure typically takes 5-10 minutes, requires no sedation, and is repeatable. Unlike liver biopsy, there is no recovery time and no tissue sampling risk. Many hepatology practices perform CPT Code 91200 as a baseline at diagnosis and then annually to monitor disease progression in patients with chronic liver conditions.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Common clinical indications:<\/strong> Chronic hepatitis B or C, nonalcoholic fatty liver disease (NAFLD\/NASH), alcoholic liver disease, primary biliary cholangitis, suspected cirrhosis<\/li><li><strong>What it measures:<\/strong> Liver stiffness as a proxy for fibrosis stage; some devices also measure controlled attenuation parameter (CAP) for steatosis<\/li><li><strong>Not a substitute for:<\/strong> Liver biopsy in cases requiring histological confirmation; some payers require biopsy first before covering 91200<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Who can bill CPT Code 91200?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 91200 may be billed by gastroenterologists, hepatologists. Eligibility rules vary by payer for GI codes such as 91065, and CMS generally follows incident-to billing rules for mid-level providers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nurse practitioners and physician assistants may bill incident-to under physician supervision, depending on the practice setting and payer contract. Independent billing by mid-levels without physician supervision is not supported under standard Medicare rules. Verify payer-specific requirements before assuming mid-level independence applies.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Eligible settings:<\/strong> Physician office (POS 11), outpatient hospital (POS 22), ambulatory surgical center (ASC) where covered<\/li><li><strong>Equipment ownership matters:<\/strong> If the practice owns the FibroScan, the global rate applies. If the device is hospital-owned and the physician provides interpretation only, modifier 26 applies<\/li><li><strong>Mid-level billing:<\/strong> Permitted incident-to under direct physician supervision; check individual payer policies for independent mid-level billing rights<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practices running <a href=\"https:\/\/pabau.com\/features\/telehealth-software\/\">virtual consultations<\/a> can deliver education, counseling, and follow-up services remotely while billing correctly.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Related CPT codes<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-93356\/\">CPT code 93356 \u2014 Myocardial Strain Imaging<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-91320\/\">CPT code 91320 \u2014 Pfizer-BioNTech COVID-19 vaccine<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-92002\/\">CPT code 92002 \u2014 Intermediate eye exam for new patients<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-92004\/\">CPT code 92004 \u2014 ophthalmological service, new patient<\/a><\/li>\n<\/ul>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Stop losing revenue to 91200 denials                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&#8217;s claims management tools help gastroenterology and hepatology practices submit cleaner claims from day one. Automate modifier selection, ICD-10 pairing, and pre-submission scrubbing.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 class=\"wp-block-heading\">CPT 91200 modifiers: TC, 26, and 59<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier selection is where most CPT Code 91200 claims go wrong. Using claims management software that flags modifier conflicts at the point of claim creation prevents the most common denial type before it reaches the payer.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-91200\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automate claims and billing with Pabau<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Reimbursement impact<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">TC<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Technical Component<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hospital\/facility owns the device; physician does not interpret the results<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pays the equipment\/technician portion only; lower rate than global<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">26<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Professional Component<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physician interprets results but does not own or operate the device<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pays physician interpretation only; typically 20-40% of global rate<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">None (global)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Global billing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physician owns device and interprets results in an office setting (POS 11)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Full reimbursement; highest rate<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct Procedural Service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">91200 performed on the same date as another procedure that shares an NCCI edit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Allows separate payment when procedures are genuinely distinct<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Key rule:<\/strong> When a physician bills 91200 in an outpatient hospital setting (POS 22), the facility bills separately for the technical component. The physician should append modifier 26 only. Billing the global rate at POS 22 is a common error that triggers automatic denial.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">ICD-10 codes to pair with CPT 91200<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 91200 requires a linked ICD-10-CM diagnosis code that establishes medical necessity. Procedure-specific CPT codes like 91200 are particularly sensitive to ICD-10 specificity: overly broad diagnosis codes can trigger denials even when the procedure is clinically appropriate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The following pairings are widely accepted.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Clinical context<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K74.60<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified cirrhosis of liver<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Monitoring known cirrhosis; many payers accept but some require more specific code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K74.69<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other cirrhosis of liver<\/td>\n<td style=\"padding:12px 16px;color:#374151\">More specific cirrhosis coding; preferred over K74.60 by some payers<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K76.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fatty (change of) liver, NEC<\/td>\n<td style=\"padding:12px 16px;color:#374151\">NAFLD staging; commonly paired but check payer LCD for acceptance<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">B18.2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Chronic viral hepatitis C<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fibrosis staging pre- or post-antiviral treatment; strong coverage support<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">B18.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Chronic viral hepatitis B without delta-agent<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hepatitis B fibrosis assessment; widely accepted by major payers<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K74.00<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hepatic fibrosis, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Baseline fibrosis staging where specific cause not yet confirmed<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K75.81<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Nonalcoholic steatohepatitis (NASH)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">NASH staging; strong medical necessity support for 91200<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Specificity note:<\/strong> Payers increasingly expect the most specific ICD-10 code available. K76.0 (fatty liver) may be challenged if K75.81 (NASH) is the documented diagnosis, and where the liver involvement is a manifestation of a systemic disease coded elsewhere. Code to the highest level of specificity supported by chart documentation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">CPT 91200 Medicare reimbursement and 2026 fee schedule<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">According to the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS fee schedule tool<\/a>, CPT Code 91200 carries 1.01 total RVUs (work, practice expense, and malpractice combined), which produces a 2026 national average payment of approximately $33.73 for the global service before geographic adjustments.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Place of service determines which party bills the professional versus technical component, not the total RVU value; verify the locality-adjusted amount through the CMS MPFS search before billing.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Billing scenario<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Place of service<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Approx. 2026 rate<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Physician owns device and interprets<\/td>\n<td style=\"padding:12px 16px;color:#374151\">POS 11 (office)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">None (global)<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">~$33.73<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Physician interprets only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">POS 22 (outpatient hospital)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Modifier 26<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">Share of the $33.73 global rate tied to the work RVU; confirm the exact split via the CMS PFS Look-Up Tool<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility\/equipment component<\/td>\n<td style=\"padding:12px 16px;color:#374151\">POS 22 (outpatient hospital)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">TC<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">Share of the $33.73 global rate tied to the practice expense RVU; confirm the exact split via the CMS PFS Look-Up Tool<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial payer rates vary considerably. Some major carriers reimburse at 120-150% of the Medicare rate for in-network gastroenterology providers. Always verify contracted rates before quoting patients an out-of-pocket cost estimate.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Commercial payer coverage policies for CPT Code 91200<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Coverage for CPT Code 91200 is not uniform across commercial payers. Aetna&#8217;s Clinical Policy Bulletin 0690 explicitly addresses noninvasive hepatic fibrosis testing, including VCTE, with coverage criteria tied to specific diagnoses and prior test requirements. Other major payers have their own stances:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Aetna:<\/strong> Covers 91200 for chronic viral hepatitis, NASH, and cirrhosis monitoring under CPB 0690. Medical necessity documentation required. Prior authorization may apply.<\/li><li><strong>Cigna:<\/strong> Generally covers VCTE\/FibroScan for hepatitis B and C staging. Some plans require evidence of prior laboratory-based fibrosis assessment before approving 91200.<\/li><li><strong>UnitedHealthcare:<\/strong> Coverage varies by plan. Office-based VCTE is generally covered for hepatology indications; prior authorization required for some commercial plans.<\/li><li><strong>BCBS:<\/strong> Varies significantly by plan and region. Some BCBS plans have local coverage determinations that require specific diagnosis criteria. Check the applicable Blue plan&#8217;s medical policy before billing.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Prior authorization is the most commonly overlooked requirement. Even when a payer covers CPT Code 91200, some require PA for the first study or for repeat studies within a 12-month period. Submitting without required PA is an automatic denial that cannot be corrected without an appeal.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a payer eligibility check and prior authorization verification before every CPT Code 91200 study. Build PA status into the patient scheduling workflow so the order is not placed until coverage is confirmed. This single step eliminates the most preventable denial category for elastography claims.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Related CPT codes: 91200 vs 76981<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 91200 and CPT 76981 both measure liver stiffness but use different technologies and have distinct billing rules. Confusing the two is a frequent coding error in GI and radiology departments that share elastography services. The <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC Codify CPT lookup<\/a> provides full descriptor comparisons for both codes.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Feature<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 91200<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 76981<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Technology<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Vibration-controlled transient elastography (VCTE)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ultrasound shear wave elastography<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Imaging guidance<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not required<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Required (ultrasound)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Primary device<\/td>\n<td style=\"padding:12px 16px;color:#374151\">FibroScan (Echosens); technology-neutral per AMA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Any real-time ultrasound unit with elastography capability<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical biller<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Gastroenterologist \/ hepatologist<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Radiologist \/ gastroenterologist with ultrasound<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare coverage<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Generally covered for hepatic fibrosis indications<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Covered; different RVU values apply<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billable same day<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes, if distinct clinical indication<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Check NCCI edits; may require modifier 59<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Billing both 91200 and 76981 on the same date for the same patient requires a clear clinical rationale in the chart note. NCCI edits may bundle these codes; modifier 59 is required to override the edit when both procedures are genuinely distinct and separately documented.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Documentation requirements for CPT Code 91200<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Incomplete documentation is the second most common reason CPT Code 91200 claims fail post-submission audit. Payers routinely conduct retrospective reviews of elastography claims, particularly for high-volume billers. Every element below must be present in the chart before the claim is submitted.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Using digital intake forms tied to the procedure type can enforce documentation completeness at the point of care, before the claim is generated. The following checklist reflects what most major payers require:<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-91200\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Customizable consent and intake forms<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Medical necessity statement:<\/strong> Clinician note stating the indication for liver elastography (e.g., staging fibrosis in chronic hepatitis C) and why noninvasive assessment is appropriate<\/li><li><strong>Relevant diagnosis documentation:<\/strong> Chart documentation supporting the linked ICD-10-CM code; laboratory results, prior imaging, or biopsy history as applicable<\/li><li><strong>Procedure report:<\/strong> Date of service, device used (e.g., FibroScan), number of measurements taken, result in kPa, interpreted fibrosis stage (F0-F4), and any technical quality notes (IQR\/M ratio)<\/li><li><strong>Provider credentials:<\/strong> Ordering and performing provider name, NPI, and specialty; supervision level if mid-level performed the study<\/li><li><strong>Prior authorization number:<\/strong> If PA was required, the PA reference number must be on the claim<\/li><li><strong>Place of service:<\/strong> Correctly coded to match the facility where the procedure was physically performed<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Common billing mistakes and denial prevention for CPT Code 91200<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most denials for CPT Code 91200 are preventable. The same root causes recur across code types: modifier errors, diagnosis codes that aren&#8217;t specific enough, and missing PA . The table below maps each common denial reason to its fix.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Denial reason<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Root cause<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Prevention<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Missing or incorrect modifier<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Global billed at POS 22, or TC\/26 split applied incorrectly<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Build POS-to-modifier rules into claim scrubber; verify device ownership at time of billing setup<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-covered ICD-10 code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Linked diagnosis not on payer&#8217;s LCD coverage list<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cross-reference diagnosis against payer LCD before submission; use most specific code supported by documentation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Lack of medical necessity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Chart note does not establish clinical rationale for the test<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Standardize documentation templates for 91200 encounters; require indication statement before order is placed<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Missing prior authorization<\/td>\n<td style=\"padding:12px 16px;color:#374151\">PA required by payer but not obtained before service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify PA requirements at scheduling; do not perform study without confirmed PA for payers that require it<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">NCCI bundling edit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">91200 billed same day as another code subject to a bundling edit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Check NCCI edits when billing 91200 with 76981 or E\/M codes; apply modifier 59 only when procedures are genuinely distinct with separate documentation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Frequency limitation exceeded<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Repeat study within payer&#8217;s defined interval (often 12 months)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Track last study date in the patient record; document clinical justification for early repeat if clinically necessary<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 class=\"wp-block-heading\">How practice management software simplifies CPT Code 91200 billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Manual claim preparation for CPT Code 91200 requires coders to check modifier rules, verify ICD-10 linkage, confirm PA status, and review NCCI edits every time they process an elastography claim. Each step is a potential failure point. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s claims management software supports gastroenterology and hepatology practices with pre-submission scrubbing that flags modifier conflicts and ICD-10 mismatches before the claim leaves the practice. Combined with digital intake forms that capture procedure-specific documentation at the point of care, practices can build a consistent, audit-ready record for every 91200 encounter.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For practices managing HIPAA-compliant billing workflows across multiple providers, centralizing claim review reduces the risk of modifier and POS errors that individual billers can miss.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 91200 is a high-value gastroenterology code with specific modifier, diagnosis, and documentation requirements that differ meaningfully by payer and place of service. Getting the global vs. split-component billing right, pairing the claim with a payer-accepted ICD-10 code, and confirming prior authorization before the study are the three highest-impact steps any practice can take to protect 91200 reimbursement.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that automate these checks with integrated claims management see fewer denials and faster payment cycles. To see how Pabau handles end-to-end billing for specialty procedures, <a href=\"https:\/\/pabau.com\/book-demo\/\">book a demo<\/a> with the team.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a broader view of visit-level documentation and rates?<\/strong> Billing guide <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-99211\/\" target=\"_blank\" rel=\"noopener\">99211<\/a> covers documentation standards and 2026 reimbursement rates that complement the elastography workflow above.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Treating Crohn&#8217;s or ulcerative colitis alongside liver disease?<\/strong> Billing guide <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j3357\/\" target=\"_blank\" rel=\"noopener\">J3357<\/a> explains reimbursement for ustekinumab injections, a biologic common in shared GI caseloads.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Looking to grow patient volume alongside cleaner billing?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/patient-acquisition-strategies\/\" target=\"_blank\" rel=\"noopener\">Patient acquisition strategies<\/a> outlines practical tactics gastroenterology and hepatology practices can use to build referral volume.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1\"><h3 class=\"schema-faq-question\">What is CPT Code 91200?<\/h3> <p class=\"schema-faq-answer\">CPT Code 91200 is a gastroenterology procedure code describing liver elastography using mechanically induced shear wave technology, performed without imaging, with interpretation and report. It is most commonly associated with FibroScan (VCTE) and is used to assess hepatic fibrosis stage noninvasively as an alternative to liver biopsy.<\/p><\/div><div class=\"schema-faq-section\" id=\"faq-question-2\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for CPT 91200?<\/h3> <p class=\"schema-faq-answer\">The 2026 Medicare national average for CPT Code 91200 is approximately $33.73 for the global service (1.01 total RVUs multiplied by the $33.4009 conversion factor), when the physician owns the device and interprets results in an office setting. Modifier 26 (professional component) and modifier TC (technical component) each pay a share of that global rate based on the work and practice expense RVUs; confirm the exact locality-adjusted split through the CMS Physician Fee Schedule lookup tool before billing.<\/p><\/div><div class=\"schema-faq-section\" id=\"faq-question-3\"><h3 class=\"schema-faq-question\">What modifiers are used with CPT Code 91200?<\/h3> <p class=\"schema-faq-answer\">The three applicable modifiers for CPT Code 91200 are: modifier TC (technical component, when the facility owns the device), modifier 26 (professional component, when the physician interprets only), and no modifier for global billing when the physician owns the device and interprets results in a POS 11 office setting. Modifier 59 may be required when 91200 is billed same-day with another procedure subject to NCCI bundling edits.<\/p><\/div><div class=\"schema-faq-section\" id=\"faq-question-4\"><h3 class=\"schema-faq-question\">What ICD-10 codes are paired with CPT 91200?<\/h3> <p class=\"schema-faq-answer\">The most commonly accepted ICD-10-CM pairings for CPT Code 91200 include K74.60 (unspecified cirrhosis), K74.69 (other cirrhosis), K76.0 (fatty liver), B18.2 (chronic viral hepatitis C), B18.1 (chronic viral hepatitis B), K74.00 (hepatic fibrosis unspecified), and K75.81 (NASH). Always select the most specific code supported by chart documentation and verify against the applicable payer LCD.<\/p><\/div><div class=\"schema-faq-section\" id=\"faq-question-5\"><h3 class=\"schema-faq-question\">What is the difference between CPT 91200 and CPT 76981?<\/h3> <p class=\"schema-faq-answer\">CPT 91200 uses vibration-controlled transient elastography (VCTE\/FibroScan) without imaging guidance, while CPT 76981 uses ultrasound shear wave elastography with imaging guidance. Both assess liver stiffness, but 76981 requires an ultrasound unit and is more commonly billed by radiologists. They may not be billed on the same date without distinct clinical documentation and modifier 59 to override NCCI edits.<\/p><\/div><div class=\"schema-faq-section\" id=\"faq-question-6\"><h3 class=\"schema-faq-question\">Why is CPT Code 91200 being denied?<\/h3> <p class=\"schema-faq-answer\">The most common denial reasons for CPT Code 91200 are: incorrect modifier (billing global at POS 22), non-covered ICD-10 pairing, missing prior authorization, lack of medical necessity documentation in the chart, and NCCI bundling edits when billed same-day with related codes. Frequency limitations (typically once per 12 months for some payers) are also a common trigger for repeat study denials.<\/p><\/div><\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Claim denials for CPT Code 91200 almost always come down to the same handful of mistakes: wrong modifier, missing ICD-10 linkage, or documentation that payers flag as lacking medical necessity. For gastroenterology and hepatology practices billing liver elastography, these errors add up fast. The 2026 Medicare national average reimbursement for CPT Code 91200 is approximately [&hellip;]<\/p>\n","protected":false},"author":77,"featured_media":154561,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"88","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[],"class_list":["post-154562","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.3 (Yoast SEO v28.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT Code 91200: Liver elastography billing guide<\/title>\n<meta name=\"description\" content=\"CPT Code 91200 is liver elastography 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