Does Blue Cross NC require prior authorization for CPT 76641?

Status not confirmed in our dataset. Confirm against the current Blue Cross NC clinical policy before submitting.

What documentation does Blue Cross NC require for CPT 76641?

Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.

How much does Medicare pay for CPT 76641 in 2026?

In 2026, the national Medicare allowable for CPT 76641 is $100.20 in an office setting and $100.20 in a facility. Commercial allowables for Blue Cross NC are typically negotiated against this benchmark.

What if Blue Cross NC denies the PA for CPT 76641?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

Blue Cross NC Prior Authorization for CPT 76641

Ultrasound exam of one breast, complete evaluation · Standard commercial plans

Status not confirmed

Source

Data pending source-document linkage. Verify against Blue Cross NC's current clinical policy before submission.

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

We don't have a source-backed prior-authorization verdict for CPT 76641 with Blue Cross NC under Standard commercial plans yet — confirm directly with the payer. The 2026 Medicare reference rate for this code is below, and you can draft the request free in Ask D3.

2026 Medicare rate for CPT 76641

Office (non-facility)

$100.20

Facility

$100.20

Total RVUs (office)

3.00

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Blue Cross NC's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 76641 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather patient history, prior conservative treatment, and clinical justification.
3Submit via the payer's provider portal or designated PA channel.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Blue Cross NC require prior authorization for CPT 76641?: Status not confirmed in our dataset. Confirm against the current Blue Cross NC clinical policy before submitting.
What documentation does Blue Cross NC require for CPT 76641?: Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.
How much does Medicare pay for CPT 76641 in 2026?: In 2026, the national Medicare allowable for CPT 76641 is $100.20 in an office setting and $100.20 in a facility. Commercial allowables for Blue Cross NC are typically negotiated against this benchmark.
What if Blue Cross NC denies the PA for CPT 76641?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Other Blue Cross NC PA lookups

CPT 70450 CPT 72148 CPT 73721 CPT 74177 CPT 73221 CPT 76942 CPT 70551 CPT 70553

All Blue Cross NC prior-authorization requirements →

CPT 76641 prior authorization by payer

Blue Cross Blue Shield Cigna Aetna Humana TRICARE Medicare

Draft the Blue Cross NC PA request for CPT 76641 — free

Ask D3 builds a payer-ready prior-authorization request with the right criteria language and documentation — backed by CMS, Medicare, and major-payer data. No signup.

Draft the 76641 PA in Ask D3 Look up another payer or code