CPT 76857
Global XXX ActiveUs exam pelvic limited
CPT 76857 Billing & Documentation Guide
CPT code 76857 (Us exam pelvic limited) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.49, a non-facility practice expense RVU of 1, and a malpractice RVU of 0.04, a total non-facility RVU of 1.53 and facility RVU of 1.53. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $52.7, though rates vary from $45.75 to $67.05 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 76857, 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 76857 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 76857 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 76857
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.49 | 0.49 |
| Practice Expense RVU | 1 | 1 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 1.53 | 1.53 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 76857
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 | $57.2 | $57.2 | $53.97 - $67.05 | 29 |
| Florida | $52.48 | $52.48 | $50.31 - $54.52 | 3 |
| Georgia | $49.86 | $49.86 | $47.75 - $51.96 | 2 |
| Illinois | $51.25 | $51.25 | $48.95 - $53.15 | 4 |
| Michigan | $49.61 | $49.61 | $48.37 - $50.85 | 2 |
| North Carolina | $48.38 | $48.38 | $48.38 - $48.38 | 1 |
| New York | $56.22 | $56.22 | $49.04 - $59.61 | 5 |
| Ohio | $48.21 | $48.21 | $48.21 - $48.21 | 1 |
| Pennsylvania | $50.66 | $50.66 | $48.29 - $53.03 | 2 |
| Texas | $50.58 | $50.58 | $48 - $52.92 | 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 76857
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 76857 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 | CPT Manual or CMS manual coding instruction |
| 76801 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 76805 | Column 1 (primary), can be billed with modifier | 9 | Mutually exclusive procedures |
Frequently Asked Questions, CPT 76857
What does CPT code 76857 mean? +
CPT code 76857 represents: Us exam pelvic limited. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 76857? +
The 2026 Medicare national average non-facility payment for CPT 76857 is $52.7. Rates range from $45.75 to $67.05 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 76857? +
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 76857? +
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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