Which payers have published criteria for Ultrasound imaging of the chest (CPT 76604)?

The imaging guidelines used by Aetna, Cigna, UnitedHealthcare include criteria that apply to this study. Whether a specific patient's plan requires prior authorization depends on the plan, so confirm on the payer's portal or by phone before scheduling.

Who reviews prior authorization requests for Ultrasound imaging of the chest (CPT 76604)?

Most commercial payers hand imaging reviews to a radiology benefit manager. For the payers tracked here, requests are reviewed using guidelines from eviCore, Carelon, CMS, UnitedHealthcare / eviCore. The request is submitted through that organization's portal rather than the health plan's general line.

What should be in the clinical notes before requesting Ultrasound imaging of the chest (CPT 76604)?

Reviewers look for a recent office visit that documents the symptoms and how long they have lasted, exam findings, results of any earlier imaging, treatments already tried and how the patient responded, and the specific question the study is expected to answer. The diagnosis code on the request should match what the notes describe.

How much does Ultrasound imaging of the chest (CPT 76604) cost?

Across 1,043 hospitals that publish their negotiated rates, the median commercial insurance rate is $276, with the middle half of rates between $156 and $476. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if Ultrasound imaging of the chest (CPT 76604) is denied?

Read the denial letter for the stated reason, then request a peer-to-peer conversation between the ordering clinician and the reviewing physician, which often resolves missing-information denials. If that fails, file a written appeal that answers the stated reason directly and attach the supporting notes. The denial letter lists the deadline and where to send the appeal.

CPT 76604: Ultrasound imaging of the chest - Prior Authorization and Price

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CPT 76604

Ultrasound imaging of the chest.

Ultrasound

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Pediatric Chest Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Chest Imaging Guidelines 1.0.2026, effective Feb 3, 2026	11 that name this code
Anthem BCBS	Carelon	Current guideline	None found
Cigna	eviCore	Pediatric Chest Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Chest Imaging Guidelines 1.0.2026, effective Feb 3, 2026	12 that name this code
Medicare	CMS	—	None found
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare	UnitedHealthcare / eviCore	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	12 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss Ultrasound imaging of the chest. Each has its own criteria for when the study is considered appropriate.

Chest Wall Mass Aetna · Cigna · UnitedHealthcare
Non-Cardiac Chest Pain Aetna · Cigna · UnitedHealthcare
Pleural Effusion Aetna · Cigna · UnitedHealthcare
Congenital Chest Diseases Aetna · Cigna · UnitedHealthcare
Asthma Aetna · Cigna · UnitedHealthcare
Bronchiolitis Aetna · Cigna · UnitedHealthcare
Lymphadenopathy Aetna · Cigna · UnitedHealthcare
Mediastinal Mass Aetna · Cigna · UnitedHealthcare
Pneumonia Aetna · Cigna · UnitedHealthcare

Typical price

Commercial insurance, median

$276

Middle half of rates: $156 to $476

Medicare, hospital outpatient

$107

Facility payment

Medicare, physician fee schedule

$61

National, non-facility

Commercial figures come from negotiated rates published by 1,043 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for Ultrasound imaging of the chest change.

CPT 76604: Ultrasound imaging of the chest - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

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