76942
US needle placement guidance
Ultrasonic guidance for needle placement (biopsy, aspiration, injection, vascular access), imaging supervision and interpretation. CMS 2026 wRVU 0.67. Add-on to almost any image-guided needle procedure that does not have its own bundled guidance code.
When to use it
76942 is the workhorse ultrasound guidance code, bundling the imaging supervision and interpretation when a needle procedure (biopsy, aspiration, injection, central venous access, paracentesis without imaging-bundled parent code) is performed under real-time US guidance. Common pairings: thyroid FNA (60100 + 76942), soft tissue mass biopsy (10005 + 76942), shoulder bursa injection (20610 if without guidance, but 20611 is the US-guided major joint version that bundles 76942), peripheral nerve block, abscess drainage.
Full guidance
Permanent recording in the chart is required for billing.
Documentation checklist
- ✓Target structure visualized in real-time during needle placement.
- ✓Images saved permanently (PACS or print) showing needle in target.
- ✓Procedure narrative documenting use of ultrasound for needle guidance.
- ✓Indication for guidance (deep target, anatomically complex, prior failed blind attempt, vascular structures nearby).
- ✓Setting modifier matches the billing entity: 26 for professional-only (hospital interpretation), TC for technical-only (facility), no modifier for global.
Common pitfalls
- !Billing 76942 alongside 20611 (US-guided major joint injection). 20611 BUNDLES the guidance — you cannot also bill 76942 for the same procedure.
- !Billing 76942 alongside 49083 (paracentesis with imaging guidance). The guidance is bundled into 49083; 76942 separate is a denial.
- !Permanent images not saved. CMS requires the guidance images to be retrievable for audit. "Used US guidance" without saved images is unbillable.
- !Billing 76942 for joint aspiration without using ultrasound. Live image during needle placement is required, not just pre-procedure scanning.
- !Multiple 76942 units for multiple targets in one session. Per CMS, 76942 is reported once per session regardless of needle passes or targets within the same anatomic region.
Payer notes
Medicare and most commercial payers cover 76942 when paired with a legitimate needle procedure and the imaging-bundled parent code is not used. Some commercial payers apply a bundling edit when 76942 follows a code that includes guidance (20611, 49083, 32555 in recent revisions); use modifier 59 only when truly separate anatomic regions are addressed in the same session. The 26/TC split applies as for all radiology services.