Billing code 76872: Transrectal ultrasoundMedicare rate & RVUs in Illinois
Transrectal ultrasound images the prostate and nearby structures to evaluate abnormalities or support clinical assessment of prostate disease.
Medicare pays $112.54–$124.05 for 76872 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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 76872 covers
A transrectal ultrasound uses an ultrasound probe placed in the rectum to image the prostate and nearby structures, including the seminal vesicles. Urologists and radiologists commonly perform it to assess prostate size, contour, or focal abnormalities in patients with findings such as an abnormal digital rectal examination or elevated prostate-specific antigen. It may also be performed during a session that includes prostate needle biopsy.
Report 76872 for the diagnostic transrectal examination, supported by documentation of the structures examined, imaging findings, and a written interpretation. A dedicated prostate volume study is distinguished by code 76873. CMS recognizes professional and technical components: report modifier 26 for the interpretation, modifier TC for the equipment and staff, or neither modifier when billing the global service. The record should identify which component the billing entity performed.
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 76872 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$112.54 to $124.05
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $122.61 | Unavailable |
| East St. Louis | $113.82 | Unavailable |
| Rest Of Illinois | $112.54 | Unavailable |
| Suburban Chicago | $124.05 | Unavailable |
How the 76872 rate is calculated
Each of 76872’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 · 76872
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.65Practice expense 2.91Malpractice 0.04
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 76872
The CMS indicators that decide how 76872 is paid alongside other services.
CMS payment indicators · 76872
Transrectal 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) | 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
76872 without 26 · national office
$120.24
Transrectal ultrasound
76872-26 · Professional component
$31.73
Pays only the interpretation and report.
76872 compared with similar codes
Compare codes
76872 vs 76873 vs 76870 vs 76856: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 76873Prostate ultrasound
- Choose 76873 for a dedicated prostate volume study. Use 76872 for diagnostic transrectal imaging that is not specifically a volume study.
- 76870Scrotal ultrasound
- 76870 images the scrotum and its contents. 76872 images the prostate through a transrectal approach.
- 76856Pelvic ultrasound
- 76856 describes a complete pelvic ultrasound, generally using an external approach. 76872 is specifically transrectal imaging of the prostate and nearby structures.
76872 billing questions
How does 76872 differ from 76873?
76872 represents diagnostic transrectal ultrasound imaging. Use 76873 for a dedicated transrectal prostate volume study.
Can 76872 be reported with a prostate biopsy?
It may be reported for diagnostic prostate imaging performed during a session that also includes a separately documented needle biopsy. The imaging record should support the ultrasound service rather than only the biopsy.
Which modifier identifies the ultrasound interpretation?
Append modifier 26 when billing the professional component, meaning the interpretation. Modifier TC identifies the technical component, including equipment and staff; billing without either modifier represents the global service.
What documentation supports 76872?
Document the transrectal examination, the anatomy imaged, the findings, and the interpretation. If a biopsy is performed in the same session, document that procedure separately.
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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