Billing code 76641: Breast ultrasoundMedicare rate & RVUs in Washington
Reports a complete diagnostic ultrasound examination of a breast, covering all breast regions and the axilla when performed, for a focal finding or symptom.
Medicare pays $104.08–$118.07 for 76641 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 76641 covers
A complete breast ultrasound evaluates all four quadrants and the retroareolar region of the breast; the axilla is included when examined. It is commonly used to assess a palpable lump, focal pain, or a finding seen on mammography. A sonographer may acquire the images, while a radiologist or other qualified physician interprets them and documents the findings in an imaging report. The examination may be performed in a hospital imaging department or an outpatient imaging center.
Select this code when the documented study is complete rather than limited to one or more specific areas. Report it for each breast examined; for a bilateral study, use modifier 50, which CMS pays at 150%. The service may be billed globally, or split into the professional interpretation with modifier 26 and the technical portion with modifier TC. The report and image documentation should support the examination's extent and the interpretation.
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 76641 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $104.08 | Unavailable |
| Seattle (King Cnty) | $118.07 | Unavailable |
How the 76641 rate is calculated
Each of 76641’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 · 76641
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.71Practice expense 2.24Malpractice 0.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 76641
The CMS indicators that decide how 76641 is paid alongside other services.
CMS payment indicators · 76641
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
76641 without 26 · national office
$100.20
Breast ultrasound
76641-26 · Professional component
$33.73
Pays only the interpretation and report.
76641 compared with similar codes
Compare codes
76641 vs 76642 vs 77065 vs 77066: national Medicare rates
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How to choose
- 76642Breast ultrasound
- 76641 represents evaluation of all four quadrants and the retroareolar region; 76642 is for a limited examination of selected areas.
- 77065Diagnostic mammogram
- 77065 is unilateral diagnostic mammography, which uses mammographic imaging rather than ultrasound.
- 77066Diagnostic mammogram
- 77066 is bilateral diagnostic mammography. It may be performed with breast ultrasound, but it describes a separate imaging modality.
76641 billing questions
When should 76641 be selected instead of 76642?
Use 76641 when the examination covers all four quadrants and the retroareolar region. A study limited to one or more areas, but not the complete breast, is reported with 76642.
How is a bilateral complete breast ultrasound reported?
Report the bilateral service with modifier 50. CMS pays the bilateral procedure at 150%.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical portion. Without either modifier, the claim represents the global service.
What documentation supports a complete examination?
The imaging report should identify the breast examined, document evaluation of all four quadrants and the retroareolar region, and include the findings and interpretation. Document axillary evaluation when performed.
Can diagnostic mammography be reported on the same date?
Diagnostic mammography may be performed during the same encounter when clinically indicated, such as evaluation of a breast symptom or imaging finding. The mammography report should document that separate examination.
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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