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Reimbursements for Musculoskeletal Ultrasound

2015 Medicare Reimbursement Schedule and
Break-Even National Average, Non-Facility


  Procedure  CPT Code  Ave. Global Reimbursement
 Ultrasound, Extremity, Complete  76881
 $117
  Ultrasound Extremity, Limited (see below)  76882
 $36

Ultrasound Guidance for Needle Placement  

 76942

$61

Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting

20611

  $92

Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting

20606

  $79

Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting

20604

 $72

Procedures Per Month

CPT Code   Reimbursement  Procedures/Mth Total/Mth  
  76881, 20611 209  20 4,108
20611  92 40 3,680
 76881 117 20 2,340
76882 36 40 1,440

      Gross/Mth $11,568

    Gross/Year $138,816

Procedures Per Month Required to Break-Even

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

$250

$96

2.6/Mth 

$450

$96

4.7/Mth 

$650

$96

6.8/Mth 

Number of Procedures Required to Recoup Equipment Cost

Example Purchase Price 

**Average Reimbursement  # of Procedures 
$10,000   $96 104
$20,000     $96 208
$30,000    $96 312

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 $20/gal should last ~ 6 months.
  • Use these CPT codes in conjunction with ICD-9 codes.
  • 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.