CPT 76856
Global XXX ActiveUs exam pelvic complete
CPT 76856 Billing & Documentation Guide
CPT code 76856 (Us exam pelvic complete) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.67, a non-facility practice expense RVU of 2.43, and a malpractice RVU of 0.05, a total non-facility RVU of 3.15 and facility RVU of 3.15. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $108.97, though rates vary from $92.96 to $142.77 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 76856, 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 76856 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 76856 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 76856
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.67 | 0.67 |
| Practice Expense RVU | 2.43 | 2.43 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 3.15 | 3.15 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 76856
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 | $120.13 | $120.13 | $112.61 - $142.77 | 29 |
| Florida | $107.06 | $107.06 | $102.48 - $111.09 | 3 |
| Georgia | $101.84 | $101.84 | $96.77 - $106.91 | 2 |
| Illinois | $104.07 | $104.07 | $99.09 - $108.85 | 4 |
| Michigan | $100.95 | $100.95 | $98.37 - $103.52 | 2 |
| North Carolina | $99.17 | $99.17 | $99.17 - $99.17 | 1 |
| New York | $116.26 | $116.26 | $100.66 - $123.42 | 5 |
| Ohio | $98.16 | $98.16 | $98.16 - $98.16 | 1 |
| Pennsylvania | $103.87 | $103.87 | $98.47 - $109.27 | 2 |
| Texas | $103.96 | $103.96 | $97.79 - $109.77 | 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 76856
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 76856 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0567T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0568T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0689T | 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 |
| 51701 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 51702 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 51798 | Column 1 (primary), can be billed with modifier | No | More extensive procedure |
| 72192 | Column 1 (primary), can be billed with modifier | 9 | Mutually exclusive procedures |
| 76801 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
Frequently Asked Questions, CPT 76856
What does CPT code 76856 mean? +
CPT code 76856 represents: Us exam pelvic complete. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 76856? +
The 2026 Medicare national average non-facility payment for CPT 76856 is $108.97. Rates range from $92.96 to $142.77 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 76856? +
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 76856? +
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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