Billing code 76642: Breast ultrasoundMedicare rate & RVUs in Florida
Real-time ultrasound of one breast targeted to a specific area or finding, such as a palpable lump or mammographic abnormality, with image documentation and axilla when scanned.
Medicare pays $81.71–$88.51 for 76642 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 9 sections
What 76642 covers
A limited breast ultrasound evaluates one breast with real-time scanning focused on a defined region rather than the entire breast. Typical indications include a palpable lump, focal pain, nipple discharge, a mass or asymmetry seen on diagnostic mammography, or short-interval follow-up of a known probably benign lesion. The axilla is included when it is scanned. A sonographer or radiologist performs the exam in an imaging center, hospital outpatient department, or breast surgeon's office, and a radiologist or breast surgeon interprets it with permanent images and a written report.
Choose this code when the exam does not cover all four quadrants plus the retroareolar region; full surveys go to the complete code. The report should state the side, the targeted area or clock-face location, findings, and an impression. The code is unilateral, so scanning both breasts is reported with modifier 50, which CMS pays at 150%. It splits into a professional component (modifier 26) for the interpretation and a technical component (modifier TC) for equipment and staff; reporting without either modifier bills the global service, used when one entity both performs and reads the study.
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.
Where 76642 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$81.71 to $88.51
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $85.63 | Unavailable |
| Miami | $88.51 | Unavailable |
| Rest Of Florida | $81.71 | Unavailable |
How the 76642 rate is calculated
Each of 76642’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 · 76642
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.66Practice expense 1.79Malpractice 0.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 76642
The CMS indicators that decide how 76642 is paid alongside other services.
CMS payment indicators · 76642
Breast ultrasound
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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
76642 without 26 · national office
$83.50
Breast ultrasound
76642-26 · Professional component
$31.40
Pays only the interpretation and report.
76642 compared with similar codes
Compare codes
76642 vs 76641 vs 76604 vs 19083: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 76641Breast ultrasound
- 76641 requires documentation of all four quadrants plus the retroareolar region; any targeted or partial exam of the breast is 76642.
- 76604Chest ultrasound
- 76604 images the chest wall or mediastinum, not breast parenchyma. Breast lumps and mammographic findings are reported with breast ultrasound codes.
- 19083Breast biopsy
- 19083 is a breast biopsy with ultrasound guidance included; 76642 describes a diagnostic breast exam and is not billed solely for imaging used to guide the biopsy needle.
76642 billing questions
When should 76642 be reported instead of 76641?
Use 76642 when the scan targets a specific area or finding in one breast. Use 76641 only when all four quadrants and the retroareolar region are examined and documented.
How is a limited ultrasound of both breasts billed?
Report 76642 once with modifier 50, which Medicare pays at 150% of the unilateral amount. Do not report two units or two lines without the bilateral modifier for Medicare.
Is axillary scanning billed separately?
No. Evaluation of the axilla is included in this code when performed, so a separate limited ultrasound of the axilla is not added for the same side.
Which modifier does a hospital-based radiologist append?
When the hospital owns the equipment and bills the technical portion, the reading radiologist reports 76642 with modifier 26 for the interpretation only. A freestanding center that performs and reads the exam bills globally without a modifier.
Can 76642 be billed for ultrasound guidance during a breast biopsy?
No. Ultrasound-guided breast biopsy code 19083 includes the imaging guidance, so 76642 is not reported just to guide the biopsy needle.
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
Show the CMS file lines behind this rate
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