Breaking Through Breast Ultrasound and Opto-Acoustic Imaging Codes to Achieve Success in 2025 Featuring an Exclusive Offer

May is Women’s Health Month—a powerful reminder of the importance of prioritizing preventive care, especially when it comes to breast health. Mammography and breast-related coding remain among the most effective tools for the early detection of breast cancer, often identifying issues before symptoms arise and leading to better outcomes. Imaging scans also play an integral role in treatment programs following a diagnosis. This month, we explore the nuances of ultrasound breast scans and opto-acoustic imaging, along with professional tips and an exclusive offer to help you succeed.

Unlocking Ultrasound Breast Scan and Opto-Acoustic Imaging Codes

76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete
76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited
+0857T Opto-acoustic imaging, breast, unilateral, including axilla when performed, real-time with image documentation, augmentative analysis and report (List separately in addition to code for primary procedure)

If you’ve been coding breast ultrasound services for a while, you may remember when CPT code 76645 was retired back in 2015. To replace these codes, two new codes 76641 and 76642 were created to give more specified options for reporting—both designed to report unilateral breast ultrasound services.

Here’s the quick breakdown:

• 76641 is for a complete exam, meaning all four quadrants of the breast and the retroareolar region must be evaluated.
• 76642 is for a limited study—basically, anything less than complete.

Both codes include imaging of the axilla when medically necessary, and you’ll often see them used alongside mammography.

Fast forward to 2023—add-on code +0857T has now entered the picture. This new Category III code was introduced for opto-acoustic (OA) imaging—a hybrid technique combining laser light and ultrasound to visualize breast masses. What was the reasoning for entering a new code? Better identification of benign pathology and, ideally, fewer unnecessary biopsies. Code +0857T is used in addition to 76641 or 76642 and active still in 2025.

Top Expert  Billing Tips for Success in 2025

1. Automated whole breast ultrasound (ABUS), for secondary screening for women with dense breasts, is reported with the regular breast ultrasound codes 76641 or 76642. This should be a screening exam, so a screening diagnosis code should be reported. However, it is important to note that ABUS is not a substitute for a screening mammogram. Note that some payers may consider ABUS investigational, and therefore, non-covered.
2. For screening ultrasound of the breast, report 76641 or 76642 and the appropriate ICD-10-CM screening diagnosis code as applicable. In addition, it is recommended that a secondary diagnosis be reported to communicate to the payer that the study was performed on a high-risk patient. Coverage will be subject to payer guidelines.
3. For ultrasounds performed bilaterally, report with modifiers LT and RT or 50, or with a quantity of 2, as per payer guidelines.
4. Typically, modifiers are not required for add-on CPT codes (such as 0857T), unless an NCCI edit is generated. If, however, your specific payer requires one, and depending upon whether you are billing for hospital (Part A) or physician (Part B) services, the following modifiers may be required: LT, RT, 50, 59 (or one of the X{EPSU} modifiers) or 76. Guidelines in the CPT manual now state that modifier 50 may not be reported with add-on codes. However, local payer policy may differ. Be sure to clarify reporting requirements for your specific region.
5. While the physician can document either by quadrant or by clock position, ICD-10-CM diagnosis codes require quadrant. Refer also to the SEER Diagram in Appendix F.
6. Report with revenue code 0402.
7. Assign modifier 26 to describe the professional component when technical services provided are hospital-based.

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