CPT code 76380 – Limited follow-up CT billing and 2026 RVUs

Key takeaways

CPT Code 76380 covers a limited or localized follow-up CT study, not a complete diagnostic scan.

The paranasal sinuses are the most common site, but the code is not sinus-specific.

A first-time limited study with no prior imaging should be checked against payer policy before you assign 76380.

In 2026, 76380 carries 0.96 work RVUs against 0.83 for 70486, so code choice turns on scope and documentation.

Pabau’s claims management software submits 76380 claims through Claim.MD and tracks claim status and denials.

CPT Code 76380: official descriptor and procedure overview

CPT Code 76380 is defined by the American Medical Association (AMA) as: Computed tomography, limited or localized follow-up study. The word “limited” carries specific clinical and billing meaning. A limited CT study evaluates fewer anatomic areas, uses fewer image acquisitions, and answers a focused clinical question rather than providing a complete diagnostic survey.

The code applies across multiple anatomic sites. The paranasal sinuses dominate clinical use because post-treatment sinus surveillance is frequently ordered as a targeted follow-up rather than a full maxillofacial CT. Other uses include limited CT of the orbits and of the temporal bones after surgery. Localized follow-up studies of other head and neck structures qualify too. The AMA descriptor does not restrict 76380 to sinuses. What defines the code is a limited or localized scope, whatever the anatomic site.

What “limited” means for billing purposes

Payers separate a limited study from a complete CT in three ways. It uses fewer image sequences and a narrower field of view, and the ordering note documents a focused indication. A study that acquires multiple reconstruction planes across the full sinus anatomy, with a comprehensive report, is not a limited study. That holds however the order labels it.

• Fewer sequences: typically coronal or axial, not both plus reformatted sagittal series
• Narrower field: targets one region (sinuses, orbits) rather than a complete head/neck survey
• Focused indication: post-treatment monitoring, follow-up to a known finding, or limited diagnostic question
• Shorter report: the radiologist addresses the specific clinical question, not a full multiregion review

What CPT 76380 covers and what it excludes

Correct code selection for a limited CT study depends on understanding the boundary between 76380 and the complete CT codes in adjacent ranges. Because the descriptor names a follow-up or localized study, a first-time limited CT does not automatically qualify. Check a first-time limited study against the payer’s policy rather than assuming it is 76380.

A study that begins as a limited follow-up and is expanded during the scan to a complete survey must be reported with the complete-study code. Billing 76380 for a study that meets the definition of 70486 is miscoding, however the order was written. The three checks below settle most cases.

Documentation requirements for CPT 76380 claims

Solid documentation is the single most effective defense against denial for a 76380 claim. CMS requires each CT study to be performed at the supervision level assigned to its code, and a qualified physician must interpret it. Strong medical billing compliance starts at the point of ordering, not at the point of billing.

• Ordering note: must state a specific clinical indication explaining why a limited (not complete) study is appropriate
• Prior imaging reference: for follow-up studies, the radiology report should reference the baseline or prior study being followed
• Radiology report elements: limited scope of study stated explicitly; anatomic area(s) evaluated; comparison to prior imaging; clinical conclusion answering the ordering question
• Supervision level: CMS sets this through the supervision indicator listed for 76380 in the Physician Fee Schedule. Check that indicator rather than assuming a level from the setting
• Technologist qualifications: a credentialed CT technologist should perform the study, with the credential kept on file for audits

One documentation mistake recurs often. The radiologist’s report describes the study as “routine sinus CT” without noting the limited scope. Payers read “routine” as equivalent to “complete” and deny 76380 as underdocumented. The report must say “limited study” or “localized follow-up.”

Medical necessity criteria for CPT 76380

Medical necessity for a limited CT study requires a documented clinical indication that justifies the follow-up or localized approach rather than ordering a complete CT. Payers evaluate the ordering note and the clinical scenario when adjudicating 76380 claims.

Common accepted indications include:

• Post-operative follow-up after functional endoscopic sinus surgery (FESS)
• Surveillance of a known sinonasal polyp or mucosal thickening following medical management
• Follow-up to confirm resolution of an acute sinusitis episode after treatment
• Localized orbit evaluation after orbital trauma when a full facial CT has already been performed
• Follow-up of a known bony lesion or foreign body in a limited anatomic region

Some indications typically do not meet medical necessity for 76380. They include new-onset symptoms without prior imaging and complex multisystem disease that needs a complete survey. Pre-operative planning, where a complete CT is standard of care, is another. Billing 76380 in those scenarios draws medical necessity denials and, if systematic, audit scrutiny.

Supporting ICD-10 diagnosis codes

The ICD-10-CM codes on the claim must support the limited-study rationale. Commonly paired codes include J32.x (chronic sinusitis by site), J33.x (nasal polyp), H05.x (orbital disorders), and Z09 (encounter for follow-up examination after completed treatment). Submitting J01.x (acute sinusitis) with 76380 may trigger a medical necessity denial because acute sinusitis is typically a clinical diagnosis. A limited CT during the acute episode is rarely covered unless conservative management has failed.

CPT 76380 vs. related radiology codes: choosing the right code

The most frequent coding errors with CPT Code 76380 involve the adjacent complete-CT codes for the same anatomic regions. The table below maps the most commonly confused codes, per AAPC’s CPT code reference.

76380 vs. 70486 is the most frequently confused comparison. The scope of the study decides it, whatever the anatomic site. A coronal-only sinus CT performed for post-FESS follow-up is 76380. A multiplanar complete survey of the maxillofacial skeleton ordered for new facial pain is 70486.

Modifiers for CPT 76380: professional, technical, and global billing

Modifier selection for 76380 follows standard radiology billing rules. The applicable modifier depends on how the technical and professional components of the study are billed.

Modifier 52 requires careful use. Appending it signals that the study was reduced from what was planned. If the study was always intended to be limited, 76380 already reflects that scope and modifier 52 is unnecessary. Only append 52 when an unexpected event truncated an otherwise standard limited study.

Medicare and payer reimbursement for CPT Code 76380

Medicare reimburses 76380 through the Medicare Physician Fee Schedule (MPFS). The CMS Physician Fee Schedule lookup tool provides current locality-specific payment amounts. National averages change every year as RVUs are recalibrated. Verify the current year’s rates before quoting reimbursement estimates.

The FastRVU 2026 RVU lookup tool provides the current work, practice expense, and malpractice RVU values for 76380 alongside the conversion factor. For 2026, 76380 carries 0.96 work RVUs and 3.96 total RVUs. The complete maxillofacial CT without contrast, 70486, carries 0.83 and 3.84. The two codes pay within a few cents of each other, so they differ in scope and documentation rather than in payment.

Pabau’s claims management software, through the Claim.MD integration, submits claims electronically and tracks their status. Your team sees each 76380 claim’s payer response in one place instead of checking a separate portal.

Prior authorization requirements by payer

Prior authorization requirements for CPT Code 76380 vary by payer and plan year. Practices that manage insurance eligibility verification and authorization workflows together reduce the lag between order and authorization. Treat prior auth as a scheduling task that starts when the study is ordered.

• Medicare (traditional): Generally does not require prior authorization for 76380. Medical necessity is reviewed after payment, in audits
• Medicare Advantage and commercial plans: Some plans use radiology benefit managers, such as EviCore, to review CT orders. Check each plan’s prior authorization list before scheduling
• BCBS plans: CT coverage policies vary by state Blue plan, so verify with the specific plan
• Medicaid: Requirements are set by each state and differ from Medicare. Confirm with the relevant state Medicaid program

When prior authorization is required, the submitted clinical criteria must match the documentation that will accompany the claim. Submitting different clinical information at authorization and at billing is a compliance risk, even when the authorization was granted.

Common denial reasons for CPT 76380 and how to prevent them

Denials on 76380 cluster around a predictable set of errors. Systematic denial management workflows track each denial code in medical billing back to its root cause so the same mistake does not recur. The most common denial patterns are:

• CO-50 (not medically necessary): the ordering note lacks a specific clinical indication, or the ICD-10 code submitted does not support a limited follow-up study. Fix: audit ordering templates to require a structured indication field before the study is scheduled.
• CO-4 (incorrect modifier): modifier 26 billed when global billing applies, or TC billed by a physician practice that also owns the equipment. Fix: confirm place-of-service and equipment ownership before selecting the modifier.
• CO-97 (included in another service): 76380 billed on the same date as a bundled complete CT study. NCCI edits may bundle 76380 and a complete CT of the same region on the same encounter. Fix: verify the NCCI edit table quarterly and document separate clinical indications when both studies are genuinely distinct.
• CO-5 (procedure inconsistent with place of service): the claim lists POS 11, a physician office, for a hospital outpatient study (POS 22). Fix: confirm the POS matches where the study was performed before submitting the claim.
• Prior authorization not obtained: claim denied because no auth on file. Fix: build an authorization check into the scheduling workflow, triggered by the CPT code, for payers that require it.

A clean claim submission for 76380 pairs the correct code with a matching ICD-10 code and the right modifier for the billing arrangement. It also carries the correct POS and any required authorization number. All five elements must be present before the claim leaves the practice.

Can CPT 76380 be billed with an ultrasound-guided biopsy code?

Sometimes. The limited CT must answer a separate clinical question, and the current NCCI edits must allow the pair.

CT guidance for biopsy is separately billable using 77012 (CT guidance for needle placement), not 76380. A radiologist may perform a limited CT to locate a lesion, then guide the biopsy with ultrasound. Those are separate imaging modalities serving different procedural roles. However, NCCI edits may bundle the imaging code with the biopsy code. That depends on the specific biopsy CPT and the edit table in effect on the date of service.

Key principles for this scenario:

• 76380 represents a diagnostic CT study, not procedural guidance; 77012 is CT guidance for intervention
• If the limited CT is performed solely to identify the target for the ultrasound-guided biopsy, payers may deny 76380 as included in the biopsy code
• If the limited CT addresses a clinical question unrelated to the biopsy site, modifier 59 or XU may support separate billing with documentation
• Check the current quarterly NCCI edit file for the specific biopsy code before billing both on the same date

How claims management software supports 76380 billing

Many radiology billing teams follow 76380 claims across a clearinghouse portal, payer websites and a denial spreadsheet. A rejected limited-CT claim can sit unnoticed for weeks.

Pabau submits claims electronically through its Claim.MD integration and tracks each claim’s status. When a payer denies a 76380 claim, the denial shows next to it. Your team can correct the report or modifier and send it again.

Code selection stays with your coders and radiologists. What changes is how quickly a denied claim gets noticed and worked, which shortens the time to payment.

Track radiology claims with Pabau

Submit 76380 and other radiology claims electronically through Pabau’s Claim.MD integration. Then track each claim’s status and denials in one place.

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Conclusion

Bill 76380 when the order, the scan and the report all describe a limited or localized follow-up study. If any one of them reads like a complete survey, bill the complete code or fix the report before the claim goes out.

The 2026 RVUs for 76380 and 70486 sit within a few hundredths of each other. The fee gives no reason to pick one over the other. Documentation decides whether a 76380 claim holds up, and a report that says “limited study” is the cheapest protection you have.

Want submitted claims and denials tracked in one place? Book a demo to see Pabau’s claim submission and status tracking through Claim.MD.

Continue your research

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Struggling with claim denials across your radiology billing? What is medical billing covers the end-to-end revenue cycle from encounter to remittance and where 76380-type codes fit.

Want to understand ERA remittance data for denied radiology claims? Electronic remittance advice (ERA) guide explains how to read 835 remittance files and identify CARC denial reason codes.

Adding 3D rendering to a limited CT? CPT code 76376 explains how 3D rendering without an independent workstation is billed as an add-on.

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