Wiki Fibroscans

[lamiller]

We were told to bill both CPT 76981 and 91200 by our representative for the fibroscan machine. We are getting paid by some insurances, but TennCare and Medicare Advantage plans are denying 91200 saying it's included in 76981. Has anyone else had this problem?

 

[daniel]

wouldn't follow your representative........ here's a breakdown I share with my team.........


Gastroenterology: Liver elastography exams

CPT Codes for Liver Elastography

As per the 2024 American College of Radiology (ACR) Ultrasound Coding Guide, there are two primary CPT codes for reporting liver elastography

• 91200: Liver elastography, mechanically induced shear wave (e.g., vibration), without imaging, with interpretation and report.

76981: Ultrasound elastography; parenchyma (e.g., organ), with imaging.

The distinguishing characteristic between the two forms of elastography is that 91200 liver elastography is performed without imaging, and 76981 or 76982 ultrasound elastography is performed with imaging. Both 91200 and 76981 or 76982 could be done either before or after a formal liver ultrasound. However, when non-imaging shear-wave elastography testing (91200) is performed in conjunction with a formal diagnostic ultrasound of the liver, it is recommended that a modifier (eg, 59) be appended to the liver ultrasound (76700 or 76705) to designate this as a separate and distinct procedure.

Code 91200 can be used for all forms of shear wave liver elastography, including both those using mechanical (transient elastography - FibroscanR) and acoustic (ARFI) techniques to generate the shear waves. The shear wave speed can be reported in meters/second (m/s) or converted to KiloPascals (kPa) making appropriate assumptions.