September 30, 2016

Contrast Ultrasound Billing Code

As of October 1, 2016, the Centers for Medicare and Medicaid (CMS) will implement HCPCS Level II code C9744 Ultrasound, abdominal, with contrast to report the technical component (TC) of outpatient hospital procedures for Medicare patients. This change affects hospital TC reporting only. The professional component (PC) billing remains unchanged and will continue to be reported with the CPT code 76705 Ultrasound, abdominal, real-time with image documentation; limited (e.g., single organ, quadrant, follow-up).

The following table illustrates the appropriate coding:


CEUS Technical Component

CEUS Professional Component

CEUS Global

Contrast Agent


Hospital IP






Hospital OP












*C9744 is effective as of October 1, 2016. C-codes are unique temporary pricing codes established by CMS, and apply only to the hospital outpatient setting. Per CMS, the C codes (Pass-Through) were established to permit implementation of section 201 of the Balanced Budget Refinement Act of 1999.HCPCS C codes are utilized to report drugs, biologicals, magnetic resonance angiography (MRA) and devices that must be used by OPPS hospitals. HCPCS C codes are reported for device categories, new technology procedures, and drugs, biologicals and radiopharmaceuticals that do not have other HCPCS code assignments.

**Q9950: Hospital Outpatient Prospective Payment System transition pass-through code for Lumason only through December 31, 2017.

***Code 96374, Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug reimbursed if the physician provider bills from a place of service 11 (office).

As noted in the table, the radiologist or other physician provider should only bill the professional component (76705-26) of the diagnostic ultrasound in the hospital setting.

Also note that the radiologist is not able to bill for the injection of contrast performed in an outpatient hospital setting. Code 96374 has a PC/TC indicator of “5” in the Medicare Physician Fee Schedule, which indicates it is an Incident To code. Incident To codes describe services covered incident to a physician’s service when they are provided by auxiliary personnel employed by the physician and working under his or her direct personal supervision. Payment may not be made by Medicare administrative contractors for these services when they are provided to hospital inpatients or patients in a hospital outpatient department. Modifiers 26 and TC cannot be used with these codes.

Reference: May/June 2016 ACR Radiology Coding Source Q&A