CPT code 76140 – Radiology consultation on outside-facility imaging

Key takeaways

CPT code 76140 applies when another physician requests an opinion on images made elsewhere and the consulting physician answers with a signed written report.

A re-read by a colleague in the same group or institution is not reportable as 76140, and no other CPT code describes it.

CPT 76145 is not a second-opinion code. It covers a medical physicist’s dose evaluation after radiation exposure exceeds an institutional review threshold.

Medicare lists 76140 as status I, so Medicare claims use the imaging code with modifier 26 when a separate interpretation is covered.

Pabau, the practice management platform we build, keeps the signed report with the claim and submits it through the Claim.MD integration.

CPT code 76140: Official descriptor and clinical scope

The American Medical Association defines CPT code 76140 as “Consultation on X-ray examination made elsewhere, written report.”

Another physician asks for an opinion on a specific study, and the consulting physician answers in a signed written report. The descriptor names X-ray examinations, so confirm with each payer whether it accepts 76140 for outside CT, MRI or ultrasound studies.

The defining feature is the consultation relationship. The consulting physician did not perform or first interpret the study, and the images were made outside their institution.

• Original study performed at: A different facility, outside the consulting physician’s institution
• Requested by: Another physician or an appropriate source such as an insurer or attorney, never the patient alone
• Service rendered: Review of the outside images plus a signed written report
• Code section: Radiology (70010-79999), Diagnostic Radiology, Other Procedures (76000-76499)
• Medicare status: I, meaning not valid for Medicare, in the 2026 Medicare Physician Fee Schedule

What CPT 76140 covers and what it excludes

The outside-facility test is the threshold question for CPT code 76140. CPT guidance says the code is not for physicians rereading films taken at their own institution. A patient who brings outside films to an office visit doesn’t qualify either, because that review is part of the E/M service.

Teleradiology needs the same check. A contracted teleradiologist giving the primary read bills the imaging code, usually with modifier 26, rather than 76140. A medical billing workflow that records where each study came from makes the code choice easy to defend at audit.

CPT 76140 vs modifier 26: How to tell them apart

CPT 76140 is a stand-alone consultation code, while modifier 26 bills the professional component of the specific imaging code. The payer and the request behind the read decide which one fits, in the order the decision path below shows. Coders sometimes reach for CPT 76145 as a “second opinion” code, but it describes medical physics work.

CPT 76145 took effect on January 1, 2021, as the first diagnostic medical physics code. A medical physicist uses it, for example, to calculate peak skin dose after a fluoroscopy-guided procedure.

A re-read within the same group fits none of these codes. No CPT code exists for it, and such re-reads are generally not separately billable. Billing one as 76140 misrepresents the service, and a payer can recoup the payment at audit.

Documentation requirements for CPT 76140

Payers examining a CPT code 76140 claim look for two kinds of evidence. They want proof that the images came from outside, and proof that a formal consultation report exists. A clean claim submission for 76140 needs every element below before the claim leaves the practice.

• Formal written report: Signed by the consulting physician, with their name, credentials, and the date of service.
• Reference to the original study: The date of the outside study, the facility name, and the modality (CT, MRI, X-ray, etc.).
• Evidence of outside origin: The imaging request, a transfer record, or DICOM header data showing the images came from an external source.
• The consultation request: Who asked for the opinion and why. A request from the patient alone does not support 76140.
• Clinical indication / ICD-10 code: Diagnosis codes that match the reason for the consultation, which is where medical necessity lives.

Keeping image-receipt timestamps in your PACS or billing system creates a contemporaneous record. That record holds up in a retrospective review long after the radiologist has forgotten the case.

Which modifiers apply, and where

CMS gives 76140 a PC/TC indicator of 9, which means the professional/technical split does not apply to it. Modifier 26 and modifier TC therefore don’t attach to 76140 itself. The modifiers below belong on the imaging-code claim, used when a payer doesn’t accept 76140.

For a payer that accepts 76140, report the code on its own unless the payer’s policy asks for more. Check that policy before you file the first claim.

Medicare status and reimbursement for CPT code 76140

Medicare does not pay CPT code 76140. The 2026 Medicare Physician Fee Schedule lists it with status indicator I and zero RVUs. Status I means the code is not valid for Medicare, which uses another code for the service. You can confirm the current status in the CMS MPFS lookup tool.

For a Medicare patient, report a covered interpretation of an outside study with the imaging code and modifier 26.

Chapter 13 of the Medicare Claims Processing Manual sets a narrower rule for emergency room patients. For their X-rays, Medicare generally pays for only one interpretation. It pays a second only in unusual, documented circumstances, such as a questionable finding that needs another physician’s expertise.

Commercial payers and Medicaid programs set their own rules and rates for 76140. Reviewing the electronic remittance advice after each 76140 payment confirms the payer applied the contracted rate and flags any underpayment.

Payer requirements and prior authorization

Coverage for 76140 starts with whether the payer recognizes the code at all. Medicare doesn’t, and commercial and Medicaid plans each publish their own policies. Some plans also apply prior authorization or decision-support checks to imaging services. Ensuring medical billing compliance means reading the payer’s policy before the first claim, not after the first denial.

• Medicare Part B: 76140 is status I, so report covered interpretations with the imaging code and modifier 26
• Commercial payers: Check the plan’s policy on outside-film consultations and any prior authorization rules
• Medicaid: Varies by state, so confirm the state fee schedule lists 76140 before billing it
• Teleradiology contexts: Confirm the consulting physician’s state licensure meets the patient’s state requirements before billing

Bundling and same-day billing rules

The National Correct Coding Initiative (NCCI) publishes procedure-to-procedure edits that stop duplicate payment for overlapping services. CMS updates those tables quarterly. Check the current table for any code you plan to bill on the same date as 76140.

Two same-day limits come from CPT guidance itself. When the same physician sees the patient face to face, reviewing outside films is part of the E/M visit. And one interpretation should never be billed twice, once as 76140 and again as the imaging code with modifier 26.

Checking denial codes on rejected 76140 claims shows whether a bundling edit or a payer policy caused the denial.

Common claim denial reasons for CPT 76140

Radiology consultation claims under CPT code 76140 fail for predictable reasons, and each denial pattern points to its fix. A structured denial management workflow should sort 76140 denials by reason code so patterns surface within 30 days of submission.

How to bill CPT 76140, step by step

Billing CPT code 76140 cleanly takes a front-to-back process that documents the outside-facility element before the claim is assembled. Pabau’s claims management software supports modifier assignment and documentation capture at each step. The workflow below applies on any billing platform.

1. Confirm outside origin and the request. Verify the images came from a different facility and another physician asked for the opinion. Record the source and receipt timestamp in your PACS or practice management system.
2. Check the payer. For Medicare, switch to the imaging code with modifier 26, because 76140 is status I. For other payers, confirm they recognize 76140.
3. Review the images and dictate a formal report. The report must reference the original study’s date, location, and modality. An unsigned addendum does not satisfy the written-report requirement.
4. Sign and finalize the report. Bill only after the report carries the physician’s signature and date. Billing on a dictated report that nobody has authenticated is a documentation violation.
5. Select the correct ICD-10 code(s). Link the most specific diagnosis code for the clinical indication. It must align with the requesting physician’s reason for the outside read.
6. Verify prior authorization status. Check the payer’s policy before submission, and flag commercial and Medicaid claims for review.
7. Submit the claim through a compliant clearinghouse. A Claim.MD clearinghouse connection validates CPT and ICD-10 pairing and catches coding edits before submission. It also returns electronic remittance for reconciliation.

Which physicians can report it

CPT does not limit 76140 to radiologists. Orthopedic surgeons, podiatrists and other physicians report it when another physician asks for a written opinion on outside films.

Three facts about the consulting physician decide eligibility. They did not perform the study, they work outside the institution that made the images, and they answer in a written report. If that physician also sees the patient that day, the film review belongs to the E/M visit instead.

How claims management software protects CPT 76140 claims

Most 76140 denials trace back to a routing decision made before anyone codes the claim. Where were the images made, who asked for the opinion, and which payer is on the claim? When those answers live only in a radiologist’s memory, the wrong code goes out.

In Pabau, the signed consultation report and the outside-study details sit on the patient record next to the claim. Claims go out through the Claim.MD integration, which checks CPT and ICD-10 pairing before the payer sees them.

Payer responses come back as electronic remittance, so your billing team can spot a repeated routing error after a handful of claims. Fixing the rule once stops the same denial from recurring across every Medicare patient.

Streamline your radiology billing workflow

Pabau connects with Claim.MD to handle modifier tracking, documentation capture, and claim submission for radiology consultation codes. See how practices reduce 76140 denial rates with automated billing workflows.

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Conclusion

Treat CPT code 76140 as a narrow code with a clear test. Bill it only when another physician asks for a written opinion on images made elsewhere, and only to a payer that recognizes it. For Medicare, the imaging code with modifier 26 is the route, and a same-group re-read has no code at all.

Asking those routing questions up front means a few claims never get filed, but far fewer come back denied or recouped. Book a demo to see how Pabau keeps radiology consultation claims routed, documented and paid.

Continue your research

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