CPT 76800
Global XXX ActiveUs exam spinal canal
CPT 76800 Billing & Documentation Guide
CPT code 76800 (Us exam spinal canal) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.1, a non-facility practice expense RVU of 4.36, and a malpractice RVU of 0.24, a total non-facility RVU of 5.7 and facility RVU of 5.7. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $196.34, though rates vary from $165.96 to $255.07 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 76800, 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 76800 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 1 units of 76800 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 76800
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.1 | 1.1 |
| Practice Expense RVU | 4.36 | 4.36 |
| Malpractice RVU | 0.24 | 0.24 |
| Total RVU | 5.7 | 5.7 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 76800
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 | $214.72 | $214.72 | $201.27 - $255.07 | 29 |
| Florida | $198.46 | $198.46 | $188.01 - $208.61 | 3 |
| Georgia | $185.32 | $185.32 | $176.2 - $194.44 | 2 |
| Illinois | $192.9 | $192.9 | $182.23 - $201.75 | 4 |
| Michigan | $184.77 | $184.77 | $178.75 - $190.79 | 2 |
| North Carolina | $177.73 | $177.73 | $177.73 - $177.73 | 1 |
| New York | $211.84 | $211.84 | $180.72 - $227.13 | 5 |
| Ohio | $177.78 | $177.78 | $177.78 - $177.78 | 1 |
| Pennsylvania | $188.28 | $188.28 | $178 - $198.56 | 2 |
| Texas | $187.76 | $187.76 | $176.71 - $197.99 | 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 76800
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 76800 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01935 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01936 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01937 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01938 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01939 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01940 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01941 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01942 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 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 |
Frequently Asked Questions, CPT 76800
What does CPT code 76800 mean? +
CPT code 76800 represents: Us exam spinal canal. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 76800? +
The 2026 Medicare national average non-facility payment for CPT 76800 is $196.34. Rates range from $165.96 to $255.07 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 76800? +
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 76800? +
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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