MSK Ultrasound
Guided Injections
Ultrasound Guided Injections
Reimbursements for Musculoskeletal Ultrasound



2014 Medicare Reimbursement Schedule and Break-Even National Average


 Procedure  CPT Code  Ave. Global Reimbursement

 Ultrasound, Extremity, Complete

76881 

$120.01

 Ultrasound Extremity, Limited (see below)

76882 

 $36.18

Ultrasound Guidance for Needle Placement 

 76942

 $74.15

Combined (Unbundled) 
with Diagnostic and Procedure Code

76881, 76942, 20610 

 $255.06



Procedures per Month

CPT Code  Reimbursement  Procedures/Mth Total/Mth 
 76881, 76942, 20610 255  20 5,100
76942, 20610  135  28 3,780
 76881 120 20 2,400
 76881 Multi-site 180 16 2,560
     Gross/Mth $13,840
    Gross/Year $166,080




Procedures Per Month Required to Break-Even

Monthly Lease Payment ** Average Reimbursement  Procedures to Break-Even

$250

$173

1.4/Mth 

$450

$173

2.6/Mth 

$650

$173

3.8/Mth 

Number of Procedures Required to Recoup Equipment Cost

Ex. Purchase Price 

**Average Reimbursement  # of Procedures 
$9,000  $173 52
$19,000    $173 110
$35,000   $173  202



76882 CPT Guidelines
: A limited, anatomic-specific ultrasound examination is performed primarily for evaluation of muscles, tendons, joints, and/or soft tissues. It is a limited examination where a specific anatomic structure such as a tendon or muscle [Moderator Note: or plantar fascia] is being assessed. The code would be used to evaluate a soft-tissue mass that may be present in an extremity where knowledge of its cystic or solid characteristic is needed.



·          Ultrasound gel at $17/gal should last ~ 6 months.

·          Printer paper $78/box is good for 1,350 prints or 337 patients.

·          Use these CPT codes in conjunction with ICD-9 codes.

·          If performing a diagnostic ultrasound of the extremities and an ultrasound

guided injection or aspiration during the same patient encounter,

all three codes may be billed: the diagnostic ultrasound (76880),

the ultrasound guidance (76942) and the code for the procedure for

which the guidance was utilized (e.g. 20610). Medicare CCI edits do

not, at present, bundle the extremity ultrasound with the ultrasound

guidance, but some private payers may. Separate recorded images

and written reports for each study should be maintained in the

patient’s record.

·          Claims for Bi-Lateral Extremity Ultrasound must have documentation to support its medical necessity. Use –50 modifier.

·          Global Amount is for Private Practice Physicians who own their equipment.

 

*For example only, your reimbursements may be higher or lower depending on your location. Check with your local provider.

**Based on gross reimbursement per month ($13,840) divided by the total number of procedures (80)

* A conversion factor of $38.0870 is used in reimbursement calculation as provided for in the Medicare, Medicaid, and SCHIP Extension Act of 2007, which was signed into law on December 29, 2007.

AMA CPT Code Find reimbursement amounts in your area.

Billing Strategies for Regional Anesthesia (w/US)