MEDICARE

Incorrect billing of CPT 76942 

Although AMA Guidelines state it is appropriate to bill CPT codes 76942, 77002, 77012, or 77021 if imaging is performed with 55700, NCCI lists 76942 as a column 2 code for 76872. You should not bill 76942 when 76872 is performed during the same session. 

In data analysis, NGS discovered widespread misuse of the modifier XU billed on 76942 when 76872 was also on the claim.  XU modifier is only for unusual non-overlapping services.