76942

🔊 CPT 76942 — Ultrasonic Guidance for Needle Placement, Imaging Supervision and Interpretation

Quick Reference

wRVU: 0.80 | Global Period: XXX (add-on code — concept does not apply) | Assistant Payable: ❌ No | Bilateral Indicator: 2 — one unit per encounter regardless of bilateral sites | PC/TC Split: ✅ Yes | Add-On Code: ✅ Yes — always paired with a primary procedure code

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📋 Clinical Description

CPT 76942 describes the real-time ultrasonic guidance service performed during a non-vascular needle-based procedure, capturing the physician’s work of visualizing the anatomical target, directing needle advancement under continuous ultrasound visualization, retaining permanent image documentation, and generating a written interpretation. This code is always an add-on to a primary procedure code — it is never reported alone. The key differentiator separating 76942 from its sibling guidance codes is its non-vascular scope: ultrasound guidance for vascular access is captured by 76937, and ultrasound guidance for specific add-on surgical procedures maps to 76998; 76942 applies exclusively to non-vascular needle placement for biopsy, aspiration, injection, or localization device.

Ultrasound-guided needle placement is used across a wide range of specialties wherever a clinician must accurately target a structure that is deep, small, non-palpable, or in proximity to critical neurovascular structures. When imaging guidance is already embedded in the primary procedure code’s descriptor (e.g., 20604, 20606, 20611 for joint procedures with US guidance included; 10005, 10006 for FNA with US guidance; 19083 for breast biopsy with US guidance), 76942 is not separately reportable — attempting to do so is the most common denial trigger for this code.

This procedure may be performed in the following clinical contexts:

• Thyroid nodule FNA or core biopsy — Real-time guidance used to target nodules ≥1 cm or smaller high-risk nodules per ACR TI-RADS or ATA guidelines; paired with 60100 (thyroid biopsy, needle) or 60101 (thyroid aspiration)
• Breast mass core needle biopsy (non-guidance-inclusive codes) — Used with primary biopsy codes that do NOT include guidance in their descriptor; note that 19083 already includes US guidance and cannot be paired with 76942
• Soft tissue mass aspiration or biopsy — Real-time US guidance to target a palpable or non-palpable soft tissue mass; paired with primary aspiration or biopsy code (e.g., 20206, 10021)
• Musculoskeletal joint/bursa/tendon injection (non-US-inclusive codes) — When the provider uses ultrasound guidance with 20610 (major joint injection, no guidance included) rather than the guidance-inclusive version 20611; documents real-time visualization of needle tip within the bursa or joint space
• Lymph node biopsy or aspiration — Fine needle aspiration or core biopsy of a non-palpable or deep lymph node; paired with 38505 (lymph node biopsy, needle) or 10021/10022 (FNA without or with imaging guidance, respectively — note 10022 includes imaging guidance, making 76942 redundant)
• Liver, renal, or retroperitoneal mass biopsy — Percutaneous needle core biopsy of solid organ or retroperitoneal mass; paired with 47000 (liver biopsy, needle), 50200 (renal biopsy), or 49180 (biopsy, retroperitoneal mass) when those codes do not include imaging in descriptor

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🔬 Anatomical & Procedural Considerations

Component Required	Detail	Coding / Documentation Impact
Real-Time Imaging	Ultrasound must be used during needle advancement, not pre- or post-procedurally	If note states “ultrasound was used to identify the site prior to injection,” guidance was NOT performed in real time — 76942 is NOT supportable; the note must state real-time or concurrent visualization
Permanent Image Retention	A saved static image or video clip must be retained as part of the medical record, showing needle trajectory or position at target	Absence of a retained image is the #1 audit failure point — the image must be retrievable in the medical record; “image reviewed but not saved” does not meet the standard
Written Interpretation	A dictated or written report documenting: anatomical site, confirmation of real-time guidance, findings, and accuracy of needle placement	The interpretation does not have to be a separate radiology report — it may be embedded in the procedure note — but it must document all four elements; a bare statement “ultrasound guided” is insufficient
Primary Procedure Code Required	76942 is an add-on code; a primary needle-based procedure code must be on the same claim	Claim submission with 76942 only, without a primary code, will deny without appeal option; verify the primary code descriptor does not already include US guidance before adding 76942
One Unit Per Encounter	CMS NCCI policy: only 1 unit of 76942 is reportable per encounter regardless of number of needle passes, lesions, or bilateral sites addressed	Billing 2 units on the same DOS will deny; modifier -76 or -77 may support a second unit only for a genuinely separate anatomic site with distinct documentation — verify with payer before submitting

Clinical Pearl

The single most important pre-billing check for 76942 is confirming that the primary procedure code does NOT already include ultrasound guidance in its own descriptor or as a bundled service per NCCI. Before appending 76942, pull the primary code’s full CPT descriptor and run it against the CMS NCCI edits table. If the primary code already contains the phrase “with ultrasound guidance” or “with imaging guidance,” 76942 is not separately billable — not even with modifier -59. The NCCI edit in these cases is a column 1/column 2 edit with no modifier indicator (0), meaning it cannot be bypassed.

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✅ Procedure Includes

• Pre-procedure identification of target structure using real-time ultrasound visualization
• Continuous ultrasound monitoring during needle advancement to the target
• Imaging supervision — physician or qualified non-physician practitioner operates or supervises the ultrasound equipment in real time
• Confirmation of needle position within target structure prior to biopsy core, aspiration, injection, or device deployment
• Permanent image documentation retained in the medical record (static image or video clip)
• Written or dictated interpretation documenting: anatomical site, use of real-time guidance, imaging findings, and confirmation of accurate needle placement
• Both the professional and technical components when billed globally (modifier -26 or -TC splits these when appropriate)

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❌ Excludes / Do Not Report Together

Code	Description	Relationship to 76942
76937	Ultrasound guidance for vascular access	Mutually exclusive by anatomic application — 76937 is for vascular access (central lines, AV fistula, angioplasty); 76942 is for non-vascular needle placement; never report both for the same needle entry
76998	Ultrasonic guidance, intraoperative (add-on)	Not separately reportable when both codes describe ultrasound guidance for the same needle placement service; per NCCI Chapter 9, 76998 and 76942 cannot be billed together for the same guidance event
20604	Arthrocentesis, aspiration and/or injection; small joint or bursa, with ultrasound guidance	76942 is bundled — this primary code includes US guidance in its descriptor; reporting 76942 with 20604 is an NCCI violation with no modifier bypass (indicator 0)
20606	Arthrocentesis, aspiration and/or injection; intermediate joint or bursa, with ultrasound guidance	Same bundling rule — guidance included in descriptor; 76942 is not separately reportable
20611	Arthrocentesis, aspiration and/or injection; major joint or bursa, with ultrasound guidance	Same bundling rule — use 20610 (without guidance) + 76942 if guidance is desired and documented; or use 20611 alone
10005	Fine needle aspiration biopsy, with ultrasound guidance; first lesion	Guidance already included; 76942 is not separately reportable
10006	Fine needle aspiration biopsy, with ultrasound guidance; each additional lesion	Same; guidance bundled
10022	Fine needle aspiration biopsy, with imaging guidance; each additional lesion	Guidance included — 76942 not separately reportable
19083	Biopsy, breast, with ultrasound guidance; first lesion	US guidance is part of the code’s value; 76942 never separately reportable with 19083
32555	Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance	Imaging guidance included — 76942 not separately reportable
49083	Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance	Imaging guidance included — 76942 not separately reportable
32408	Core needle biopsy, lung or mediastinum, with CT or radiologic guidance	Imaging guidance included — 76942 not separately reportable
Diagnostic ultrasound, same region (e.g., 76536, 76700, 76705, 76770, 76775, 76881, 76882)	Diagnostic ultrasound of the same anatomical region	Per NCCI Chapter 9, a diagnostic ultrasound of the same anatomic region and 76942 on the same DOS are not separately reportable — report only one; if regions differ, modifier -59 or -XS required on the lower-value code
E/M codes (992xx / 920xx)	Office visit, any level	Separately reportable only when modifier -25 is appended to the E/M code, documenting a significant, separately identifiable evaluation and management service beyond the pre-procedure assessment

Bundling Alert — Global Period is XXX, Not 000/010/090

CPT 76942 is an add-on code with a global period designation of XXX, meaning the global surgery concept does not apply. There are no post-procedure follow-up days bundled, no global window to track for this code specifically. However, the primary procedure code to which 76942 is appended will carry its own global period (e.g., 000, 010, or 090), and any E/M services within that primary code’s global window are bundled into the primary procedure’s payment — not into 76942 separately. The most common audit risk here is billing a same-day E/M without modifier -25 on the E/M code; the -25 modifier belongs on the E/M code, never on 76942 itself.

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🌳 Code Tree — Radiology: Diagnostic Ultrasound / Ultrasonic Guidance Procedures

CPT 76506-76999 Diagnostic Ultrasound (Radiology Section)  
│  
├── 76506-76536 Head and Neck Ultrasound  
│ └── 76536 Soft tissue, face and neck (e.g., thyroid, parathyroid, salivary gland)  
│  
├── 76604-76645 Chest / Breast Ultrasound  
│ └── 76641-76642 Breast ultrasound, complete / limited  
│  
├── 76700-76776 Abdominal and Retroperitoneal Ultrasound  
│  
├── 76801-76857 Obstetric / Pelvic Ultrasound  
│  
├── 76870-76886 Scrotum / Extremity / Other Ultrasound  
│ ├── 76881 Ultrasound, extremity, non-vascular; complete  
│ └── 76882 Ultrasound, extremity, non-vascular; limited  
│  
├── 76930-76998 Ultrasonic Guidance Procedures  
│ ├── 76930 Ultrasonic guidance, pericardiocentesis  
│ ├── 76932 Ultrasonic guidance, endomyocardial biopsy  
│ ├── 76936 Ultrasound guided compression repair of arterial pseudoaneurysm  
│ ├── 76937 Ultrasound guidance for vascular access (vascular procedures only)  
│ ├── ▶▶ 76942 ◀◀ Ultrasonic guidance for needle placement (biopsy, aspiration, injection, localization device), imaging supervision and interpretation ← YOU ARE HERE (Global: XXX — add-on)  
│ ├── 76945 Ultrasonic guidance for chorionic villus sampling  
│ ├── 76946 Ultrasonic guidance for amniocentesis  
│ ├── 76948 Ultrasonic guidance for aspiration of ova  
│ ├── 76998 Ultrasonic guidance, intraoperative (add-on)  
│ └── 76999 Unlisted ultrasound procedure (e.g., A-scan)

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💰 RVU & Reimbursement Profile

Component	Value
Work RVU (wRVU)	0.80 (CMS RVU26A — effective January 1, 2026; reflects -2.5% efficiency adjustment applied to MPFS per CY 2026 Final Rule CMS-1832-F)
Total Global RVU (Non-Facility)	2.51
Global Period	XXX (add-on code — global surgery concept does not apply)
Bilateral Indicator	2 — bilateral, different payment rules; CMS policy allows only 1 unit per encounter, not per side or per lesion
Assistant Surgeon	❌ Not payable
Co-Surgeon	❌ Not applicable
Team Surgery	❌ Not applicable
PC/TC Split	✅ Yes — Indicator 1; Professional Component (-26) and Technical Component (-TC) split applies
Modifier -51 Exempt	Yes — add-on code; modifier 51 does not apply
Medicare Global Payment (Non-Facility, 2026 non-APM CF $33.4009)	~$83.84(global);$26.72 (-26 professional only); ~$57.11 (-TC technical only)
Anesthesia	No separate anesthesia billing — guidance is performed under the same anesthesia or local as the primary procedure

PC/TC Billing Rules for 76942

CPT 76942 has a PC/TC indicator of 1, meaning the global code captures both the professional interpretation and the technical equipment/staff cost. In a private office (POS 11), the provider bills the global code and receives the full ~$83.84iftheyowntheultrasoundequipment.Ina\ast \ast hospitaloutpatientdepartment(POS22)\ast \ast ,thephysicianbillsonlythe\ast \ast professionalcomponentwithmodifier-26\ast \ast ($26.72), and the hospital separately bills the technical component through the facility fee schedule. Never bill the global code when practicing in a facility that owns the equipment — this results in overpayment recoupment.

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🏷️ Modifier Reference

Modifier	Name	When to Apply
-26	Professional Component	Interpreting physician bills only for real-time supervision and written interpretation; the facility or a separate entity owns/operates the equipment; do NOT bill global or TC from the same entity on the same claim line
-TC	Technical Component	Facility or practice bills only for equipment, supplies, and sonography staff; the professional interpretation is billed separately by another provider
-RT	Right Side	Apply when payer requires laterality identification for a paired bilateral structure (e.g., right breast, right kidney, right shoulder)
-LT	Left Side	Apply when payer requires laterality identification for a paired bilateral structure
-59	Distinct Procedural Service	Apply to the lower-value code when a diagnostic ultrasound of a different anatomic region is performed on the same DOS; documents that the two services addressed separate anatomic sites — not a bypass for same-region bundling
-XS	Separate Structure	Preferred over -59 where payers accept X-modifiers; indicates the diagnostic ultrasound and 76942 addressed a separate anatomic structure; stronger documentation requirement than -59
-76	Repeat Procedure by Same Physician	Apply when the same provider performs ultrasound guidance for a second needle-based procedure at a genuinely different anatomic site on the same DOS; requires distinct clinical documentation for each site; pre-verify with payer before submitting 2 units
-77	Repeat Procedure by Different Physician	Apply when a different provider performs a second ultrasound guidance service at a distinct site on the same DOS; each provider bills under their own NPI
-52	Reduced Services	Guidance initiated but not completed to full standard (e.g., inadequate imaging window); document reason thoroughly
-53	Discontinued Procedure	Guidance stopped due to patient safety concern prior to completion; document clinical basis

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🩺 Common ICD-10-CM Pairings

Thyroid / Head & Neck

ICD-10 Code	Description	HCC?	Clinical Notes
E04.1	Nontoxic single thyroid nodule	❌ No	Most common pairing for thyroid FNA; supports biopsy of a documented single nodule; use when laterality or multi-nodularity is absent from documentation
E04.2	Nontoxic multinodular goiter	❌ No	Use when multiple nodules are documented and one is being biopsied; avoid parent code E04 — use full specificity
D34	Benign neoplasm of thyroid gland	❌ No	Apply when a previously characterized benign thyroid tumor requires repeat sampling
C73	Malignant neoplasm of thyroid gland	✅ HCC 12	Use when biopsy is performed for confirmed or suspected thyroid malignancy — confirm with provider documentation before assigning

Breast

ICD-10 Code	Description	HCC?	Clinical Notes
N63.11	Unspecified lump in the right breast, upper outer quadrant	❌ No	Apply when a non-specific breast mass is the indication; use the most specific quadrant code documented
N63.21	Unspecified lump in the left breast, upper outer quadrant	❌ No	Left side equivalent — always code to specific quadrant when documented
N63.10	Unspecified lump in the right breast, unspecified quadrant	❌ No	Use only when quadrant location is entirely absent from documentation; query for specificity when possible
N63.20	Unspecified lump in the left breast, unspecified quadrant	❌ No	Left-side equivalent of N63.10 — least specific; query for quadrant
Z12.31	Encounter for screening mammogram for malignant neoplasm of breast	❌ No	May be added as secondary when procedure is part of a screening follow-up work-up

Musculoskeletal / Joint / Soft Tissue

ICD-10 Code	Description	HCC?	Clinical Notes
M75.101	Unspecified rotator cuff syndrome, right shoulder	❌ No	Use for US-guided subacromial bursa or rotator cuff injection with 20610 + 76942; document right side
M75.102	Unspecified rotator cuff syndrome, left shoulder	❌ No	Left-side equivalent
M75.100	Unspecified rotator cuff syndrome, unspecified shoulder	❌ No	Least specific; use only when laterality is absent and unqueryable
M79.622	Pain in left upper arm	❌ No	Secondary code when pain is the presenting symptom driving the injection
M67.811	Other specified disorders of tendon, right shoulder	❌ No	Use when tendon-specific pathology (not rotator cuff syndrome) drives the injection
D21.9	Benign neoplasm of connective and other soft tissue, unspecified	❌ No	Use for soft tissue mass aspiration/biopsy without confirmed malignancy

Lymph Node / Oncologic

ICD-10 Code	Description	HCC?	Clinical Notes
R59.9	Enlarged lymph nodes, unspecified	❌ No	Use for lymph node FNA or core biopsy when etiology is not yet established; avoid parent code R59
C77.9	Secondary and unspecified malignant neoplasm of lymph node, unspecified	✅ HCC 12	Use when biopsy is for staging of a known primary malignancy with suspected nodal involvement — confirm with provider
C80.1	Malignant (primary) neoplasm, unspecified	✅ HCC 12	Apply when a primary site for a confirmed malignancy is not yet determined and biopsy targets a mass of unknown origin

Abdominal / Retroperitoneal

ICD-10 Code	Description	HCC?	Clinical Notes
K76.89	Other specified diseases of liver	❌ No	Use for liver biopsy (with 47000) when a specific liver disease is not yet coded
C22.0	Liver cell carcinoma	✅ HCC 12	Use when biopsy targets a hepatic mass with documented or suspected HCC
R16.0	Hepatomegaly, not elsewhere classified	❌ No	Secondary code when hepatomegaly is the clinical finding driving biopsy
D20.0	Benign neoplasm of retroperitoneum	❌ No	Use for retroperitoneal mass biopsy (with 49180) without confirmed malignancy

Coding Specificity Reminder

Because 76942 is an add-on guidance code used across virtually every body system and specialty, the ICD-10-CM selection is driven entirely by the primary procedure’s indication — not by the fact that guidance was used. The most common specificity gap is laterality (right vs. left for breast, kidney, shoulder, lymph node) and anatomical site (quadrant for breast, specific joint vs. unspecified for MSK). ICD-10-CM specificity requirements are not optional — query the provider when laterality or site specificity is missing from documentation before defaulting to an unspecified code.

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🏥 MS-DRG Considerations (Inpatient)

Inpatient Coding Reminder

CPT 76942 is performed exclusively in the outpatient, office, or ASC setting as an add-on to a primary needle-based procedure. There are no routine MS-DRG assignments for ultrasound guidance as a standalone service. Inpatient admission driven solely by a needle biopsy, aspiration, or injection procedure — where 76942 would be appended — would not be supported by any MAC or utilization review body. If a patient is admitted inpatient for an unrelated diagnosis and also undergoes a needle procedure with ultrasound guidance, the complete inpatient procedure is captured by the appropriate ICD-10-PCS code, which incorporates the approach and technique — no separate PCS guidance code is typically needed. See PCS section below.

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🔧 ICD-10 PCS Equivalents (Inpatient Facility Coding)

Note

CPT 76942 has no direct ICD-10-PCS equivalent code because inpatient PCS coding captures ultrasound guidance within the Approach character (e.g., Percutaneous approach) and does not typically assign a separate guidance code. When ultrasound imaging is performed intraoperatively during a percutaneous needle procedure in the inpatient setting, the imaging guidance is considered integral to the Percutaneous Approach character of the PCS procedure code. The body-system-specific PCS code for the primary procedure (biopsy, aspiration, injection) captures the full service. Example PCS root operations that may apply depending on the primary procedure: Drainage (9) for aspiration, Excision (B) for needle biopsy, Introduction (0) for injection — all under the Medical and Surgical (0) or Administration (3) sections.

PCS Code	Full Description	Applicable Context
(Site-specific)	Percutaneous approach codes in the Medical and Surgical section capture the biopsy, drainage, or injection — guidance is integral to the Percutaneous Approach character (3)	All non-vascular needle procedures performed percutaneously under imaging guidance
(Imaging section codes may be assigned separately)	Section B — Imaging codes may be assigned as additional procedure codes when a separately documented ultrasound imaging service is performed during the inpatient stay	Only when a distinct, separately documented imaging service is present in the operative/procedure note

PCS Character Guidance for Percutaneous Needle Procedures

Position	Character	Value	Definition
1	Section	0	Medical and Surgical
2	Body System	(Variable)	Determined by target organ/body part (e.g., F = Hepatobiliary System, H = Skin and Breast, M = Bursae and Ligaments)
3	Root Operation	9 or B	Drainage (9) for aspiration; Excision (B) for core needle biopsy
4	Body Part	(Variable)	Specific body part targeted (e.g., right breast, liver, lymphatic)
5	Approach	3	Percutaneous — captures needle insertion through the skin; ultrasound guidance is integral to Percutaneous approach, not separately coded
6	Device	Z	No Device (for most biopsies/aspirations); drainage device if leaving a catheter
7	Qualifier	X or Z	X = Diagnostic (biopsy); Z = No Qualifier (therapeutic aspiration or injection)

PCS Approach: Why Ultrasound Guidance Is Not a Separate PCS Code

• Use Percutaneous Approach (3) whenever the needle enters through the skin to reach a deep internal structure — this is the PCS standard regardless of whether ultrasound, fluoroscopy, or CT guidance was used
• The ICD-10-PCS Official Guidelines and Coding Clinic do not instruct coders to assign a separate imaging code merely because ultrasound guidance was used intraoperatively alongside a percutaneous procedure
• When the sole inpatient procedure is imaging guidance without a concurrent interventional procedure documented, coders should query the physician and/or assign the most appropriate Imaging section (B) code — but this scenario is clinically rare

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📝 Coding Examples

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Example 1 — Office (POS 11): Ultrasound-Guided Thyroid Nodule FNA, Global Billing

Clinical Scenario: A 54-year-old female presents to her endocrinologist’s office for fine needle aspiration of a 1.4 cm hypoechoic thyroid nodule identified on prior neck ultrasound, meeting ATA biopsy criteria. Under real-time ultrasound guidance, the provider advances a 25-gauge needle into the nodule with continuous sonographic visualization, performing three passes. A permanent image is saved in the medical record confirming needle position within the nodule. The procedure note documents: “Real-time ultrasound guidance was used throughout needle advancement. Permanent image retained. The nodule was successfully sampled.” No separately identifiable E/M was documented beyond the pre-procedure assessment.

Field	Code	Rationale
CPT Primary	60100	Thyroid biopsy, percutaneous needle — primary procedure for FNA of thyroid nodule
CPT Add-On	76942	Ultrasonic guidance for needle placement — separately reportable because 60100 does NOT include imaging guidance in its descriptor; global code billed because provider owns the US equipment (POS 11)
PDx	E04.1	Nontoxic single thyroid nodule — most specific code matching the documented single hypoechoic nodule without functional abnormality

Note

No separate E/M is billable in this scenario because the provider did not document a significant, separately identifiable evaluation beyond the pre-procedure assessment. If a comprehensive thyroid disease management discussion occurred and was separately documented, modifier -25 on the E/M code (not on 76942) could support an E/M claim — but the documentation bar is high and subject to payer audit scrutiny.

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Example 2 — Office (POS 11): Ultrasound-Guided Major Joint Injection, Professional Component Only (Radiologist at Hospital-Based Clinic)

Clinical Scenario: A 62-year-old male with right shoulder rotator cuff syndrome presents to a hospital-based orthopedic clinic for a corticosteroid injection into the right subacromial bursa. The treating orthopedist performs the injection under real-time ultrasound guidance using the clinic’s ultrasound equipment (owned by the hospital). A permanent image is saved confirming needle tip position within the bursa. The provider documents: “Ultrasound guidance was used in real time during needle placement into the right subacromial bursa. Injectate spread was confirmed sonographically. Permanent image retained and interpreted.” The primary injection code does not include ultrasound guidance in its descriptor. A separate E/M was documented at the same visit for evaluation of worsening pain and discussion of alternative treatment options.

Field	Code	Rationale
CPT 1 (E/M)	99213-25	Office visit, established patient, low complexity — modifier -25 on the E/M because a significant, separately identifiable evaluation was documented beyond the pre-procedure assessment; -25 goes on the E/M, not on 76942
CPT 2 (Primary Procedure)	20610	Arthrocentesis/injection, major joint (shoulder) — without ultrasound guidance; not 20611, because the hospital owns the equipment and billing is split
CPT 3 (Guidance)	76942-26	Ultrasound guidance, professional component only — provider bills -26 because the hospital (facility) owns the ultrasound equipment; facility bills the -TC separately; global billing would be incorrect here
PDx	M75.101	Unspecified rotator cuff syndrome, right shoulder — most specific; laterality documented

Warning

The -25 modifier belongs on the E/M code (99213), never on 76942. Appending -25 to the guidance code is incorrect and will result in a claim processing error. Additionally, billing 76942 globally (without -26) when the facility owns the equipment constitutes a duplicate payment risk — the facility will separately bill the technical component, and the physician will have been overpaid if the global code is used.

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Example 3 — ASC: Ultrasound-Guided Soft Tissue Mass Biopsy, Bundling Pitfall Avoided

Clinical Scenario: A 47-year-old female is scheduled for percutaneous needle core biopsy of a 2.3 cm soft tissue mass in the right posterior thigh, non-palpable and adjacent to the sciatic nerve. The procedure is performed in an ASC under real-time ultrasound guidance. The radiologist advances a 14-gauge core biopsy needle under continuous sonographic visualization, targeting the mass and avoiding the adjacent nerve. Three core samples are obtained. A permanent image is saved. The radiologist dictates a full interpretation report. The ASC coder initially considers whether to also report 76881 (extremity ultrasound) because the radiologist scanned the thigh prior to the biopsy, but only a single anatomic region was addressed — no separate diagnostic ultrasound of a different region was performed.

Field	Code	Rationale
CPT 1 (Primary)	20206	Biopsy, muscle — percutaneous needle core; primary procedure; does NOT include imaging guidance in its descriptor, making 76942 separately reportable
CPT 2 (Guidance)	76942-26	Ultrasound guidance, professional component — ASC owns the equipment; radiologist bills -26; ASC bills -TC through facility claim
PDx	D21.9	Benign neoplasm of connective and other soft tissue, unspecified — use until pathology confirms; if mass is suspicious for malignancy per provider documentation, query before defaulting to a benign code

Note

Bundling alert: Reporting 76881 (extremity ultrasound, complete) in addition to 76942 for the same anatomic region (right thigh) on the same DOS is an NCCI violation per Chapter 9 — a diagnostic ultrasound and ultrasound guidance for needle placement of the same anatomic region are not separately reportable. Since the radiologist scanned the thigh only to guide the biopsy and did not perform a separately documented complete extremity ultrasound for a distinct clinical indication at a different site, 76881 is not billable. Only 76942 is reportable for the guidance service.

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⚠️ Common Coding Pitfalls

• Billing 76942 with a primary code that already includes ultrasound guidance: This is the #1 denial trigger for this code. CPT codes 20604, 20606, 20611, 10005, 10006, 10022, 19083, 19084, 32408, 32555, 49083, and others already include imaging guidance as part of their descriptor value. Adding 76942 to these codes is an NCCI violation — in most cases, a column 1/column 2 edit with modifier indicator 0, meaning modifier -59 cannot bypass it. Always verify the primary code’s descriptor before appending 76942.

• Billing multiple units of 76942 per encounter: CMS NCCI policy explicitly states the unit of service is the patient encounter, not the number of needle passes, lesions biopsied, aspirations performed, or bilateral sites treated. Billing 2+ units on the same DOS will result in denial. If a genuinely separate anatomic site was addressed with separate clinical documentation, modifier -76 or -77 may support a second unit — but this requires pre-verification with the MAC and very robust documentation of clinical distinctness.

• Billing 76942 globally when the facility owns the equipment: In hospital outpatient departments (POS 22) or hospital-based ASCs, the physician’s ownership of the ultrasound equipment is typically absent — the facility owns it. Billing the global 76942 in these settings results in a duplicate payment scenario (physician overpaid; facility also bills -TC). The physician must bill with modifier -26 in facility settings.

• Reporting 76942 together with a same-region diagnostic ultrasound on the same DOS: Per NCCI Chapter 9, a diagnostic ultrasound of the same anatomic region and ultrasound guidance (76942) for a procedure on that same region are not separately reportable on the same DOS. The exception applies only when each service addresses a different anatomic region, requiring modifier -59 or -XS on the lower-value code. Appending -59 to bypass a same-region edit is a compliance violation.

• Placing modifier -25 on 76942 instead of on the E/M code: Modifier -25 is a modifier for evaluation and management codes — it signals that a separately identifiable E/M was performed on the same day as a minor procedure. It belongs on the E/M code, not on the procedure or guidance code. Appending -25 to 76942 is procedurally incorrect and may cause claim processing errors or manual review flags.

• Using 76942 for vascular access procedures: CPT 76942 is strictly for non-vascular needle placement. Ultrasound guidance for vascular access (central venous lines, arterial access, AV fistula procedures) is captured by 76937. Using 76942 for a vascular access procedure is a miscoding error that will be denied when the primary vascular code’s NCCI pairing is reviewed.

• Defaulting to unspecified ICD-10-CM codes without querying: Because 76942 is used across every body system, the laterality and site specificity requirements of the accompanying diagnosis codes are equally broad and complex. The most common specificity gap is laterality for paired structures (breast quadrant, right vs. left shoulder, right vs. left kidney) and primary lesion characterization (benign vs. malignant, confirmed vs. suspected). Query the provider before assigning unspecified codes — ICD-10-CM specificity requirements are not optional, and unspecified codes increase audit exposure and may fail medical necessity review.

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📎 Sources

^{1. AMA CPT 2026 Professional Edition — CPT Code 76942 full descriptor and parenthetical guidelines} · ^{2. CMS RVU26A Relative Value Files, effective January 1, 2026 — wRVU 0.80, global period XXX, PC/TC Indicator 1, bilateral indicator 2} · ^{3. CMS CY 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F), published November 2025 — conversion factors $33.4009(non-APM)/$33.5675 (APM); -2.5% efficiency adjustment to wRVUs} · ^{4. CMS NCCI Policy Manual, Chapter 9 — Radiology Services, 2025-2026: same-region diagnostic ultrasound and 76942 not separately reportable; unit of service = encounter; bundling with 76998} · ^{5. CMS NCCI Policy Manual, Chapter 5 — Cardiac and EP procedure bundling rules (76942 not reportable with 33202-33275, 93600-93662)} · ^{6. ICD-10-CM Official Guidelines for Coding and Reporting FY2026 — specificity, laterality, and query standards} · ^{7. ICD-10-PCS Official Guidelines for Coding and Reporting FY2026 — Percutaneous Approach and guidance integral to approach character} · ^{8. Transcure Medical Billing — “CPT Code 76942: Description, Cost, Scenarios, and Rules” (April 2026) — 2026 RVU values, PC/TC payment breakdown, bundling rules} · ^{9. Athelas TBH — “CPT 76942: Ultrasound Guidance: Diagnostic Radiology Essentials” (March 2026) — documentation requirements, real-time imaging standard} · ^{10. Healthcare Inspired LLC — “2026 CPT Code Changes for Prostate Biopsy” (December 2025) — 76942 bundling with new 2026 prostate biopsy codes 55705-55714} · ^{11. AAPC CPT Code 76942 Reference — code classification, Ultrasonic Guidance Procedures range} · ^{12. KZA Coding Coaches — “Injections with Ultrasound Guidance” — NCCI guidance on when 76942 is separately reportable vs. bundled with injection codes} · ^{13. AAPM&R Coding Q&A, May 2017 — SI joint injection coding with 76942, bundling context}