Billing code 76873: Prostate ultrasoundMedicare rate & RVUs in Washington
Reports transrectal ultrasound measurement of prostate volume with image documentation, often used to assess enlargement or support prostate treatment planning.
Medicare pays $185.37–$209.24 for 76873 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 76873 covers
This study uses a transrectal ultrasound probe to measure prostate volume and retain images documenting the examination. Urologists and radiologists commonly perform it in an office or imaging setting when prostate size is needed to evaluate enlargement or plan treatment, including prostate brachytherapy. It is a volume-measurement service rather than simply documenting that transrectal imaging was performed.
Select the code when the record supports a prostate volume study and includes the required image documentation. The report should identify the measurement and provide the corresponding images; documentation of a general prostate ultrasound alone does not establish this specific service. CMS recognizes professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies equipment and staff, and billing without either modifier represents the global service.
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 76873 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $185.37 | Unavailable |
| Seattle (King Cnty) | $209.24 | Unavailable |
How the 76873 rate is calculated
Each of 76873’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 · 76873
RVUs × geographic indexes × conversion factor
Work1.51
1.51 RVUs× 1.000 GPCI
Practice expense3.76
3.76 RVUs× 1.000 GPCI
Malpractice0.08
0.08 RVUs× 1.000 GPCI
Adjusted RVUs
5.3500
Conversion factor
$33.4009
Medicare rate
$178.69
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 76873
The CMS indicators that decide how 76873 is paid alongside other services.
CMS payment indicators · 76873
Prostate 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
76873 without 26 · national office
$178.69
Prostate ultrasound
76873-26 · Professional component
$76.15
Pays only the interpretation and report.
76873 compared with similar codes
Compare codes · National
76873 vs 76872 vs 76856: Medicare rates
How to choose
- 76872Transrectal ultrasound
- 76872 describes general transrectal ultrasound imaging. Choose 76873 when the service specifically measures prostate volume and includes image documentation.
- 76856Pelvic ultrasound
- 76856 is a complete pelvic ultrasound, not a dedicated transrectal prostate volume study. The approach and documented examination determine which service is represented.
76873 billing questions
How is this different from 76872?
Use 76873 for a documented prostate volume study. Code 76872 describes transrectal ultrasound imaging more generally; the record should support the specific volume measurement when reporting 76873.
What documentation supports 76873?
Document that a prostate volume study was performed, include the volume measurement, and retain the required images. A note stating only that transrectal ultrasound was performed does not explain the volume-study service.
When should modifier 26 or TC be used?
Use modifier 26 for the professional interpretation and modifier TC for the technical service, including equipment and staff. Submit the code without a component modifier when billing the global service.
Can 76873 be reported with another prostate ultrasound code?
The documentation should distinguish a prostate volume study from general transrectal imaging. Do not treat 76873 as a substitute for 76872 when the record supports only the broader ultrasound 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
Show the CMS file lines behind this rate
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