$98.63
76641 requires documentation of all four quadrants plus the retroareolar region; any targeted or partial exam of the breast is 76642.
On this page
CMS RVU26D · Effective 2026-10-01
76642 Breast ultrasound Medicare reimbursement rates in Vermont
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. Compare 76642 office and facility rates across CMS payment localities in Vermont.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 76642 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$82.08
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Radiology
About 76642: Limited unilateral breast ultrasound
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.
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.
CMS billing rules for 76642
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
Where the value comes from
- Work RVU0.66 · 26%
- Practice expense (office) RVU1.79 · 72%
- Malpractice RVU0.05 · 2%
664K
Medicare services in 2024 · #190 by national volume
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.
76642 compared with similar codes
Office rates for Vermont, from the same CMS release.
$59.90
76604 images the chest wall or mediastinum, not breast parenchyma. Breast lumps and mammographic findings are reported with breast ultrasound codes.
$466.38
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.
Compare 76642 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Vermont →
Office / nonfacility
$82.08
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 76642 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
8,739
- Code
- 76642
- Physician work
- 0.66
- Practice expense
- 1.79
- Malpractice
- 0.05
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.66 | × 1.000 | 0.6600 |
| Practice expense | 1.79 | × 0.990 | 1.7721 |
| Malpractice | 0.05 | × 0.506 | 0.0253 |
| Total RVUs | 2.4574 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$82.08
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.66 | 1 |
| Practice expense | 1.79 | 0.99 |
| Malpractice | 0.05 | 0.506 |
(0.66 × 1 + 1.79 × 0.99 + 0.05 × 0.506) × $33.4009 = $82.08
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
8,73676641,,Ultrasound breast complete,A,,0.71,2.24,,2.24,NA,0.05,3.00,3.00,1,XXX,0.00,0.00,0.00,0,1,0,0,0,9,,33.4009,09,0,99,3.44,3.44,0.06
8,73776641,26,Ultrasound breast complete,A,,0.71,0.26,,0.26,,0.04,1.01,1.01,1,XXX,0.00,0.00,0.00,0,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8,73876641,TC,Ultrasound breast complete,A,,0.00,1.98,,1.98,NA,0.01,1.99,1.99,1,XXX,0.00,0.00,0.00,0,1,0,0,0,9,,33.4009,01,0,99,3.18,3.18,0.02
8,73976642,,Ultrasound breast limited,A,,0.66,1.79,,1.79,NA,0.05,2.50,2.50,1,XXX,0.00,0.00,0.00,0,1,0,0,0,9,,33.4009,09,0,99,2.88,2.88,0.06
8,74076642,26,Ultrasound breast limited,A,,0.66,0.24,,0.24,,0.04,0.94,0.94,1,XXX,0.00,0.00,0.00,0,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8,74176642,TC,Ultrasound breast limited,A,,0.00,1.55,,1.55,NA,0.01,1.56,1.56,1,XXX,0.00,0.00,0.00,0,1,0,0,0,9,,33.4009,01,0,99,2.64,2.64,0.02
8,74276700,,Us exam abdom complete,A,,0.79,2.57,,2.57,NA,0.06,3.42,3.42,1,XXX,0.00,0.00,0.00,4,0,0,0,0,9,,33.4009,09,0,88,3.46,3.46,0.07
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817