CPT 76511
Global XXX ActiveOph us dx quan a-scan only
CPT 76511 Billing & Documentation Guide
CPT code 76511 (Oph us dx quan a-scan only) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.62, a non-facility practice expense RVU of 1.08, and a malpractice RVU of 0.02, a total non-facility RVU of 1.72 and facility RVU of 1.72. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $59.35, though rates vary from $52.04 to $75.36 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 76511, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 76511 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 76511 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 76511
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.62 | 0.62 |
| Practice Expense RVU | 1.08 | 1.08 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 1.72 | 1.72 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 76511
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $64.5 | $64.5 | $60.95 - $75.36 | 29 |
| Florida | $58.2 | $58.2 | $56.2 - $59.95 | 3 |
| Georgia | $55.95 | $55.95 | $53.68 - $58.22 | 2 |
| Illinois | $56.91 | $56.91 | $54.69 - $59.08 | 4 |
| Michigan | $55.53 | $55.53 | $54.4 - $56.65 | 2 |
| North Carolina | $54.79 | $54.79 | $54.79 - $54.79 | 1 |
| New York | $62.84 | $62.84 | $55.45 - $66.17 | 5 |
| Ohio | $54.32 | $54.32 | $54.32 - $54.32 | 1 |
| Pennsylvania | $56.94 | $56.94 | $54.45 - $59.43 | 2 |
| Texas | $56.96 | $56.96 | $54.16 - $59.51 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 76511
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 76511 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0689T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0690T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 76519 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 76942 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 76970 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 76983 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 76986 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 76998 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 76511
What does CPT code 76511 mean? +
CPT code 76511 represents: Oph us dx quan a-scan only. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 76511? +
The 2026 Medicare national average non-facility payment for CPT 76511 is $59.35. Rates range from $52.04 to $75.36 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 76511? +
Radiology codes rely heavily on the professional/technical split: modifier 26 (professional component only) and TC (technical component only). Also common: 50 (bilateral imaging), 76 (repeat by same physician), 77 (repeat by different physician), and LT/RT for laterality.
What bundling edits apply to CPT 76511? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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