Who reviews prior authorization requests for Performing a thorough ultrasound examination of a joint (CPT 76881)?

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 Performing a thorough ultrasound examination of a joint (CPT 76881)?

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.

CPT 76881: Performing a thorough ultrasound examination of a joint - Prior Authorization and Price

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CPT 76881

Performing a thorough ultrasound examination of a joint.

Ultrasound

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Pediatric Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	24 that name this code
Anthem BCBS	Carelon	Current guideline	None found
Cigna	eviCore	Pediatric Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	24 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	24 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 Performing a thorough ultrasound examination of a joint. Each has its own criteria for when the study is considered appropriate.

Infection Aetna · Cigna · UnitedHealthcare
Post-Operative Follow-Up Aetna · Cigna · UnitedHealthcare
Tissue Growths, Masses and Cysts Aetna · Cigna · UnitedHealthcare
Arthritis and Joint Degeneration Aetna · Cigna · UnitedHealthcare
Foreign and Loose Bodies Aetna · Cigna · UnitedHealthcare
General Pain Aetna · Cigna · UnitedHealthcare
Ligament and Fascia Injury Aetna · Cigna · UnitedHealthcare
Muscle/Tendon Unit Injuries/Diseases Aetna · Cigna · UnitedHealthcare
Foreign Body Aetna · Cigna · UnitedHealthcare
Infection/Osteomyelitis Aetna · Cigna · UnitedHealthcare
Limping Child Aetna · Cigna · UnitedHealthcare
Popliteal (Baker) Cyst Aetna · Cigna · UnitedHealthcare
Bone Tumors Aetna · Cigna · UnitedHealthcare
Congenital Anomalies of the Foot and Lower Extremity Aetna · Cigna · UnitedHealthcare
Fracture and Dislocation Aetna · Cigna · UnitedHealthcare
Inflammatory Musculoskeletal Disease Aetna · Cigna · UnitedHealthcare
Soft Tissue and Bone Masses Aetna · Cigna · UnitedHealthcare

Typical price

Commercial insurance, median

$314

Middle half of rates: $187 to $550

Medicare, hospital outpatient

$107

Facility payment

Medicare, physician fee schedule

$54

National, non-facility

Commercial figures come from negotiated rates published by 986 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 Performing a thorough ultrasound examination of a joint change.

CPT 76881: Performing a thorough ultrasound examination of a joint - 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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