CPT code 76604: Chest ultrasound, diagnostic examination2026 Medicare rate & RVUs in Puerto Rico
Reports diagnostic ultrasound of the chest, including assessment of pleural spaces, chest wall, or mediastinal structures for a clinical concern such as pleural fluid.
In Puerto Rico, Medicare pays $61.54 for 76604 in the office.
Check a contract rate as a % of Medicare · 76604 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 76604 covers
This service uses real-time ultrasound to evaluate chest structures, with saved images supporting the examination and interpretation. Common clinical questions include whether pleural fluid is present and the appearance of the pleural space; the examination can also assess chest-wall or mediastinal structures. Radiologists, pulmonologists, emergency physicians, and other qualified practitioners may perform or interpret it in office, hospital, or emergency settings.
Report 76604 when the documented service is a diagnostic chest ultrasound, rather than breast imaging or ultrasound used only to guide a procedure. The record should identify the clinical question, area examined, images obtained, and findings or interpretation. A physician may report the professional component with modifier 26, the equipment and staff portion with modifier TC, or the global service without either modifier. CMS applies the diagnostic imaging multiple-procedure reduction to both the technical and professional components when applicable.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Puerto Rico compares for 76604
Across 109 of 109 payment localities, the office rate for 76604 runs from $54.66 in Arkansas to $80.20 in San Benito County, CA. Puerto Rico pays $61.54. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$61.54
- Los Angeles, CA · California$68.69+$7.15
- Washington, DC area · District of Columbia$69.49+$7.95
- Miami, FL · Florida$65.32+$3.78
- Chicago, IL · Illinois$63.62+$2.08
- Manhattan, NY · New York$69.84+$8.30
- Alaska · Alaska$72.67+$11.13
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $55.39 | — |
| ArkansasArkansas | $54.66 | — |
| ArizonaArizona | $59.64 | — |
| Bakersfield, CACalifornia | $64.69 | — |
| Chico, CACalifornia | $64.53 | — |
| El Centro, CACalifornia | $64.53 | — |
| Fresno, CACalifornia | $64.53 | — |
| Hanford, CACalifornia | $64.53 | — |
| Madera, CACalifornia | $64.53 | — |
| Merced, CACalifornia | $64.53 | — |
| Modesto, CACalifornia | $64.53 | — |
| Napa, CACalifornia | $74.27 | — |
| Oxnard, CACalifornia | $68.33 | — |
| Redding, CACalifornia | $64.53 | — |
| Rest of CaliforniaCalifornia | $64.53 | — |
| Riverside, CACalifornia | $65.07 | — |
| Sacramento, CACalifornia | $67.58 | — |
| Salinas, CACalifornia | $67.32 | — |
| San Diego, CACalifornia | $68.80 | — |
| Marin County, CACalifornia | $78.49 | — |
| San Francisco, CACalifornia | $78.44 | — |
| San Benito County, CACalifornia | $80.20 | — |
| Santa Clara County, CACalifornia | $79.96 | — |
| San Luis Obispo, CACalifornia | $66.25 | — |
| Santa Cruz, CACalifornia | $69.37 | — |
| Santa Maria, CACalifornia | $67.54 | — |
| Santa Rosa, CACalifornia | $70.07 | — |
| Stockton, CACalifornia | $64.53 | — |
| Vallejo, CACalifornia | $74.19 | — |
| Visalia, CACalifornia | $64.53 | — |
| Yuba City, CACalifornia | $64.53 | — |
| ColoradoColorado | $63.56 | — |
| ConnecticutConnecticut | $64.95 | — |
| DelawareDelaware | $60.57 | — |
| Fort Lauderdale, FLFlorida | $62.99 | — |
| Rest of FloridaFlorida | $60.20 | — |
| Atlanta, GAGeorgia | $62.16 | — |
| Rest of GeorgiaGeorgia | $57.12 | — |
| Hawaii, Guam, HIHawaii | $65.91 | — |
| IowaIowa | $56.71 | — |
| IdahoIdaho | $57.04 | — |
| East St. Louis, ILIllinois | $59.61 | — |
| Rest of IllinoisIllinois | $58.58 | — |
| Suburban Chicago, ILIllinois | $63.63 | — |
| IndianaIndiana | $57.34 | — |
| KansasKansas | $56.45 | — |
| KentuckyKentucky | $56.53 | — |
| New Orleans, LALouisiana | $58.99 | — |
| Rest of LouisianaLouisiana | $56.44 | — |
| Metropolitan Boston, MAMassachusetts | $69.51 | — |
| Rest of MassachusettsMassachusetts | $63.22 | — |
| Baltimore area, MDMaryland | $64.76 | — |
| Rest of MarylandMaryland | $61.66 | — |
| Rest of MaineMaine | $57.29 | — |
| Southern Maine, MEMaine | $60.15 | — |
| Detroit, MIMichigan | $60.87 | — |
| Rest of MichiganMichigan | $57.85 | — |
| MinnesotaMinnesota | $61.11 | — |
| Metropolitan Kansas City, MOMissouri | $58.64 | — |
| Metropolitan St. Louis, MOMissouri | $59.20 | — |
| Rest of MissouriMissouri | $55.55 | — |
| MississippiMississippi | $55.12 | — |
| MontanaMontana | $61.12 | — |
| North CarolinaNorth Carolina | $57.84 | — |
| North DakotaNorth Dakota | $60.13 | — |
| NebraskaNebraska | $57.00 | — |
| New HampshireNew Hampshire | $62.56 | — |
| Northern New JerseyNew Jersey | $68.87 | — |
| Rest of New JerseyNew Jersey | $65.75 | — |
| New MexicoNew Mexico | $58.13 | — |
| NevadaNevada | $60.88 | — |
| NYC suburbs and Long Island, NYNew York | $71.37 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $66.15 | — |
| Queens, NYNew York | $70.40 | — |
| Rest of New YorkNew York | $58.62 | — |
| OhioOhio | $57.65 | — |
| OklahomaOklahoma | $56.46 | — |
| Portland, OROregon | $65.46 | — |
| Rest of OregonOregon | $60.47 | — |
| Metropolitan Philadelphia, PAPennsylvania | $63.44 | — |
| Rest of PennsylvaniaPennsylvania | $57.75 | — |
| Rhode IslandRhode Island | $62.63 | — |
| South CarolinaSouth Carolina | $57.83 | — |
| South DakotaSouth Dakota | $60.01 | — |
| TennesseeTennessee | $56.70 | — |
| Austin, TXTexas | $63.30 | — |
| Beaumont, TXTexas | $57.40 | — |
| Brazoria, TXTexas | $60.55 | — |
| Dallas, TXTexas | $60.90 | — |
| Fort Worth, TXTexas | $60.52 | — |
| Galveston, TXTexas | $60.71 | — |
| Houston, TXTexas | $61.63 | — |
| Rest of TexasTexas | $58.92 | — |
| UtahUtah | $58.55 | — |
| VirginiaVirginia | $59.95 | — |
| Virgin Islands, VIUnited States Virgin Islands | $61.54 | — |
| VermontVermont | $59.90 | — |
| Rest of WashingtonWashington | $63.10 | — |
| King County, WAWashington | $70.89 | — |
| WisconsinWisconsin | $58.28 | — |
| West VirginiaWest Virginia | $56.59 | — |
| WyomingWyoming | $60.69 | — |
76604 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$54.66
$72.67
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $72.67 | 1 |
| AL | $55.39 | 1 |
| AR | $54.66 | 1 |
| AZ | $59.64 | 1 |
| CA | $64.53–$80.20 | 29 |
| CO | $63.56 | 1 |
| CT | $64.95 | 1 |
| DC | $69.49 | 1 |
| DE | $60.57 | 1 |
| FL | $60.20–$65.32 | 3 |
| GA | $57.12–$62.16 | 2 |
| GU | $65.91 | 1 |
| HI | $65.91 | 1 |
| IA | $56.71 | 1 |
| ID | $57.04 | 1 |
| IL | $58.58–$63.63 | 4 |
| IN | $57.34 | 1 |
| KS | $56.45 | 1 |
| KY | $56.53 | 1 |
| LA | $56.44–$58.99 | 2 |
| MA | $63.22–$69.51 | 2 |
| MD | $61.66–$69.49 | 3 |
| ME | $57.29–$60.15 | 2 |
| MI | $57.85–$60.87 | 2 |
| MN | $61.11 | 1 |
| MO | $55.55–$59.20 | 3 |
| MS | $55.12 | 1 |
| MT | $61.12 | 1 |
| NC | $57.84 | 1 |
| ND | $60.13 | 1 |
| NE | $57.00 | 1 |
| NH | $62.56 | 1 |
| NJ | $65.75–$68.87 | 2 |
| NM | $58.13 | 1 |
| NV | $60.88 | 1 |
| NY | $58.62–$71.37 | 5 |
| OH | $57.65 | 1 |
| OK | $56.46 | 1 |
| OR | $60.47–$65.46 | 2 |
| PA | $57.75–$63.44 | 2 |
| PR | $61.54 | 1 |
| RI | $62.63 | 1 |
| SC | $57.83 | 1 |
| SD | $60.01 | 1 |
| TN | $56.70 | 1 |
| TX | $57.40–$63.30 | 8 |
| UT | $58.55 | 1 |
| VA | $59.95–$69.49 | 2 |
| VI | $61.54 | 1 |
| VT | $59.90 | 1 |
| WA | $63.10–$70.89 | 2 |
| WI | $58.28 | 1 |
| WV | $56.59 | 1 |
| WY | $60.69 | 1 |
How the 76604 rate is calculated
Each of 76604’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 76604
RVUs × geographic indexes × conversion factor
Work0.58
0.58 RVUs× 1.000 GPCI
Practice expense1.20
1.20 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.8300
Conversion factor
$33.4009
Medicare rate
$61.12
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
8,733
- Code
- 76604
- Physician work
- 0.58
- Practice expense
- 1.20
- Malpractice
- 0.05
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.58 | × 1.000 | 0.5800 |
| Practice expense | 1.20 | × 1.011 | 1.2132 |
| Malpractice | 0.05 | × 0.985 | 0.0493 |
| Total RVUs | 1.8424 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$61.54
Office: (0.58 × 1 + 1.2 × 1.011 + 0.05 × 0.985) × $33.4009 = $61.54
Payment rules and modifiers for 76604
The CMS indicators that decide how 76604 is paid alongside other services.
CMS payment indicators · 76604
Chest ultrasound, diagnostic examination
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 4 | Diagnostic imaging reduction applies to the technical component (and professional component) of additional services. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
76604 without 26 · national office
$61.12
Chest ultrasound, diagnostic examination
76604-26 · Professional component
$27.72
Pays only the interpretation and report.
How 76604 has changed in Puerto Rico
76604 · Office / nonfacility
$61.54
Effective 2026-10-01
The base rate is $5.03 higher than on 2025-10-01, moving from $56.51 to $61.54 (8.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$56.51changed to$61.54
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.59 changed to 0.58
- Practice expense RVU 1.11 changed to 1.20
- Malpractice RVU 0.04 changed to 0.05
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$57.15changed to$56.51
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.08 changed to 1.11
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$56.22changed to$57.15
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$57.87changed to$56.22
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.06 changed to 1.08
- Malpractice RVU 0.05 changed to 0.04
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$57.61changed to$57.87
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$60.50changed to$57.61
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.10 changed to 1.06
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$68.73changed to$60.50
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.32 changed to 1.10
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$80.92changed to$68.73
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.60 changed to 1.32
- Malpractice RVU 0.04 changed to 0.05
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$90.93changed to$80.92
- Conversion factor 36.0391 changed to 36.0896
- Work RVU 0.55 changed to 0.59
- Practice expense RVU 1.92 changed to 1.60
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$91.92changed to$90.93
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.95 changed to 1.92
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$79.64changed to$91.92
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.92 changed to 1.95
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$68.07changed to$79.64
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.90 changed to 1.92
- Practice expense GPCI 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$68.32changed to$68.07
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$67.98changed to$68.32
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$67.44changed to$67.98
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.91 changed to 1.90
- Practice expense GPCI 0.692 changed to 0.705
- Malpractice GPCI 0.271 changed to 0.293
Held through RVU15B.
January 1, 2014
RVU14A
$66.34changed to$67.44
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 2.05 changed to 1.91
- Practice expense GPCI 0.678 changed to 0.692
- Malpractice GPCI 0.249 changed to 0.271
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $66.34
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $61.54 | Not available in this setting | RVU26D |
| 2026-07-01 | $61.54 | Not available in this setting | RVU26C |
| 2026-04-01 | $61.54 | Not available in this setting | RVU26B |
| 2026-01-01 | $61.54 | Not available in this setting | RVU26A |
| 2025-10-01 | $56.51 | Not available in this setting | RVU25D |
| 2025-07-01 | $56.51 | Not available in this setting | RVU25C |
| 2025-04-01 | $56.51 | Not available in this setting | RVU25B |
| 2025-01-01 | $56.51 | Not available in this setting | RVU25A |
| 2024-10-01 | $57.15 | Not available in this setting | RVU24D |
| 2024-07-01 | $57.15 | Not available in this setting | RVU24C |
| 2024-04-01 | $57.15 | Not available in this setting | RVU24B |
| 2024-03-09 | $57.15 | Not available in this setting | RVU24AR |
| 2024-01-01 | $56.22 | Not available in this setting | RVU24A |
| 2023-10-01 | $57.87 | Not available in this setting | RVU23D |
| 2023-07-01 | $57.61 | Not available in this setting | RVU23C |
| 2023-04-01 | $57.61 | Not available in this setting | RVU23B |
| 2023-01-01 | $57.61 | Not available in this setting | RVU23A |
| 2022-10-01 | $60.50 | Not available in this setting | RVU22D |
| 2022-07-01 | $60.50 | Not available in this setting | RVU22C |
| 2022-04-01 | $60.50 | Not available in this setting | RVU22B |
| 2022-01-01 | $60.50 | Not available in this setting | RVU22A |
| 2021-10-01 | $68.73 | Not available in this setting | RVU21D |
| 2021-07-01 | $68.73 | Not available in this setting | RVU21C |
| 2021-04-01 | $68.73 | Not available in this setting | RVU21B |
| 2021-01-01 | $68.73 | Not available in this setting | RVU21A |
| 2020-10-01 | $80.92 | Not available in this setting | RVU20D |
| 2020-07-01 | $80.92 | Not available in this setting | RVU20C |
| 2020-04-01 | $80.92 | Not available in this setting | RVU20B |
| 2020-01-01 | $80.92 | Not available in this setting | RVU20A |
| 2019-10-01 | $90.93 | Not available in this setting | RVU19D |
| 2019-07-01 | $90.93 | Not available in this setting | RVU19C |
| 2019-04-01 | $90.93 | Not available in this setting | RVU19B |
| 2019-01-01 | $90.93 | Not available in this setting | RVU19A |
| 2018-10-01 | $91.92 | Not available in this setting | RVU18D |
| 2018-07-01 | $91.92 | Not available in this setting | RVU18C |
| 2018-04-01 | $91.92 | Not available in this setting | RVU18B |
| 2018-01-01 | $91.92 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $79.64 | Not available in this setting | RVU17D |
| 2017-07-01 | $79.64 | Not available in this setting | RVU17C |
| 2017-04-01 | $79.64 | Not available in this setting | RVU17B |
| 2017-01-01 | $79.64 | Not available in this setting | RVU17A |
| 2016-10-01 | $68.07 | Not available in this setting | RVU16D |
| 2016-07-01 | $68.07 | Not available in this setting | RVU16C |
| 2016-04-01 | $68.07 | Not available in this setting | RVU16B |
| 2016-01-01 | $68.07 | Not available in this setting | RVU16A |
| 2015-10-01 | $68.32 | Not available in this setting | RVU15D |
| 2015-07-01 | $68.32 | Not available in this setting | RVU15C |
| 2015-04-01 | $67.98 | Not available in this setting | RVU15B |
| 2015-01-01 | $67.98 | Not available in this setting | RVU15A |
| 2014-10-01 | $67.44 | Not available in this setting | RVU14D |
| 2014-07-01 | $67.44 | Not available in this setting | RVU14C |
| 2014-04-01 | $67.44 | Not available in this setting | RVU14B |
| 2014-01-01 | $67.44 | Not available in this setting | RVU14A |
| 2013-10-01 | $66.34 | Not available in this setting | RVU13D |
| 2013-07-01 | $66.34 | Not available in this setting | RVU13C |
| 2013-04-01 | $66.34 | Not available in this setting | RVU13B |
| 2013-01-01 | $66.34 | Not available in this setting | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
76604 billing questions
When should 76604 be used instead of 76641 or 76642?
Use 76604 for diagnostic ultrasound of thoracic structures such as the pleural space, chest wall, or mediastinum. Codes 76641 and 76642 describe breast ultrasound, with the choice depending on the extent of the breast examination.
Can the professional and technical portions be billed separately?
Yes. Report modifier 26 for the physician's interpretation and modifier TC for the equipment and staff portion; billing without either modifier represents the global service.
Can 76604 be reported with thoracentesis?
It may be reported when a distinct diagnostic chest examination is performed and documented. Do not treat imaging that is integral to the thoracentesis as a separate diagnostic examination.
What documentation supports 76604?
Document the reason for the study, the thoracic area evaluated, saved images, and the findings or interpretation. The record should make clear that the service was diagnostic rather than solely procedural guidance.
How does the multiple-procedure reduction affect this code?
CMS applies the diagnostic imaging multiple-procedure reduction to the technical and professional components when applicable. The reduction can therefore affect either separately billed component.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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