​​Effective October 15, 2025, Independence Blue Cross and Independence Administrators will align the reimbursement for both Hospital Outpatient and Ambulatory Payment Classification contracted providers for claims processed on the new platform.

Reimbursement guidelines

The reimbursement for facility providers for breast ultrasound screening services (CPT codes 76641 and 76642) on an 837I claim form, whether performed unilaterally or bilaterally, will be reimbursed as a packaged service.   

There is no additional reimbursement adjustment for these services when reported bilaterally on an institutional claim.  

Billing guidelines

CPT codes 76641 and 76642 represent conditional bilateral services. When performed bilaterally, 76641 or 76642 should be reported on a single line with Modifier 50. Reporting the services performed bilaterally on two separate lines with Modifier LT and RT will result in the denial of the second reported line for exceeding the Facility MUE value of 1.   

Learn more

Visit our dedicated Platform Transition page to stay informed of our ongoing platform transition.

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