In most cases liver fibrosis is asymptomatic. Patients with metabolic dysfunction-associated steatotic liver disease, chronic hepatitis, abnormal liver enzymes or other long-standing liver conditions might develop substantial fibrosis without symptoms.
That is one reason why liver elastography has become beneficial in hepatology, gastroenterology and other specialties that care for patients at risk for chronic liver disease. Tests such as FibroScan can assist clinicians in measuring liver stiffness without having to turn to an invasive liver biopsy right away.
But the test poses a different difficulty for billing: There’s no specific ICD-10 code that’s a “FibroScan code.”
Providers should document the clinical justification for performing the research and choose the CPT code that describes the exact elastography technique performed and link it to an ICD-10-CM diagnosis that supports the medical necessity of the service.
That distinction matters. CMS notes that CPT/HCPCS services submitted on claims are matched with ICD-10-CM diagnoses, and an inappropriate code combination can result in rejection or nonpayment. Coverage can also vary by Medicare Administrative Contractor and payer policy.
This guide provides ICD-10 coding for liver elastography and FibroScan, pertinent CPT codes, typical diagnostic combinations, modifiers, documentation requirements, and denial and remark codes providers may see.
What Is Liver Elastography?
Liver elastography is a noninvasive method of estimating tissue stiffness. Increased liver stiffness can be associated with fibrosis and, at more advanced stages, cirrhosis.
Several technologies can perform elastography, and this is where coding begins to matter.
A FibroScan examination typically uses vibration-controlled transient elastography. The device generates mechanical vibrations and measures the resulting shear waves to estimate liver stiffness. In standard non-imaging transient elastography, the test produces measurements rather than a conventional diagnostic image.
Ultrasound elastography, on the other hand, can use imaging to evaluate the elasticity of liver parenchyma. Magnetic resonance elastography uses MRI technology to evaluate tissue stiffness.
These services are related clinically, but they are not necessarily reported with the same CPT code.
What Is the Main CPT Code for FibroScan?
For a conventional non-imaging FibroScan examination, the CPT code commonly associated with the service is:
| CPT Code | Service | Typical Use |
|---|---|---|
| 91200 | Liver elastography using mechanically induced shear waves, without imaging, including interpretation and report | Transient elastography such as Fibroscan |
CPT 91200 belongs to the diagnostic gastroenterology procedure family. The code represents liver elastography performed without imaging.
The words “without imaging” are especially important.
A practice should not select 91200 merely because someone in the office calls the test “elastography.” Coding should reflect the technology and service actually performed.
CPT 91200 and FibroScan
When a patient undergoes standard vibration-controlled transient elastography and the equipment produces liver stiffness measurements rather than diagnostic ultrasound images, CPT 91200 is generally the code to investigate first.
The documentation should show that the service was performed, why it was medically necessary, the measurements obtained, and the clinician’s interpretation.
Simply documenting “FibroScan completed” provides less support than a complete procedure report.
CPT 91200 vs. 76981: Do Not Treat Them as Interchangeable
One of the most common coding problems occurs when CPT 91200 and CPT 76981 are treated as alternative codes for the same exact procedure.
They are not.
CPT 76981
CPT 76981 represents ultrasound elastography involving the parenchyma of an organ. The liver is a common organ evaluated using this technology.
The practical difference is straightforward:
| Feature | CPT 91200 | CPT 76981 |
|---|---|---|
| Liver-specific | Yes | No; may apply to organ parenchyma such as liver |
| Uses elastography | Yes | Yes |
| Imaging | Non-imaging | Imaging-based ultrasound elastography |
| Common application | FibroScan/transient elastography | Ultrasound shear-wave elastography |
| Interpretation/report | Included in the service | Associated with diagnostic imaging service |
Before submitting either code, check the equipment used and the actual procedure report. The manufacturer’s product name alone should not determine the CPT code.
Other CPT Codes Related to Elastography
Depending on the technology and clinical purpose, additional elastography codes may be relevant.
CPT 76982
CPT 76982 is used for ultrasound elastography involving a first target lesion rather than evaluation of an entire organ’s parenchyma.
This distinction is important because routine liver fibrosis assessment typically focuses on diffuse liver tissue rather than a focal lesion.
CPT 76983
CPT 76983 is an add-on code for additional target lesions evaluated with ultrasound elastography.
It should not be treated as a standalone code. Published coding guidance identifies it as an add-on service reported in conjunction with 76982 when applicable.
CPT 76391
CPT 76391 applies to magnetic resonance elastography.
MR elastography uses MRI technology together with induced tissue vibration to evaluate tissue stiffness. It may be used for liver evaluation in selected patients, but it should not be confused with transient elastography performed using FibroScan equipment.
A simplified comparison looks like this:
| CPT | Procedure Type | Typical Liver Application |
|---|---|---|
| 91200 | Non-imaging liver elastography | Fibrosis assessment/FibroScan |
| 76981 | Ultrasound elastography of organ parenchyma | Imaging-based liver stiffness assessment |
| 76982 | Ultrasound elastography, first target lesion | Focal lesion evaluation |
| 76983 | Additional target lesion | Additional lesion assessment |
| 76391 | MR elastography | MRI-based liver stiffness assessment |
Practices should verify current CPT instructions, payer policy, NCCI edits, and equipment-specific documentation before choosing among these codes.
ICD-10 Codes for Liver Elastography and FibroScan
The diagnosis submitted with an elastography claim should describe why the patient required the study.
Providers should never use the ordering of an elastography test as a diagnosis of fibrosis or cirrhosis. The ICD-10-CM code must be documented in the patient’s medical record.
Some of the most relevant liver-related codes include the following.
| ICD-10-CM Code | Diagnosis |
|---|---|
| K74.00 | Hepatic fibrosis, unspecified |
| K74.01 | Hepatic fibrosis, early fibrosis |
| K74.02 | Hepatic fibrosis, advanced fibrosis |
| K74.1 | Hepatic sclerosis |
| K74.2 | Hepatic fibrosis with hepatic sclerosis |
| K74.3 | Primary biliary cirrhosis/cholangitis classification |
| K74.4 | Secondary biliary cirrhosis |
| K74.5 | Biliary cirrhosis, unspecified |
| K74.60 | Unspecified cirrhosis of liver |
| K74.69 | Other cirrhosis of liver |
| K75.81 | Nonalcoholic steatohepatitis |
| K76.0 | Fatty change of liver, NEC |
| K76.89 | Other specified diseases of liver |
| K76.9 | Liver disease, unspecified |
| R74.01 | Elevated liver transaminase levels |
| R94.5 | Abnormal results of liver function studies |
CMS’s FY 2026 classification includes K74.00, K74.01 and K74.02 for unspecified, early, and advanced hepatic fibrosis, respectively, along with the cirrhosis categories within K74.
CMS coverage materials addressing liver-related testing also identify conditions such as hepatic fibrosis, NASH, fatty liver, elevated transaminases, and abnormal liver function results as clinically relevant diagnoses in liver-disease assessment. That does not mean every payer automatically covers elastography for each diagnosis; the applicable policy still needs to be checked.
Fatty Liver and Steatohepatitis Codes
Fatty liver disease is one of the most common situations in which fibrosis risk needs to be assessed.
Two codes providers frequently encounter are:
K76.0 – Fatty (change of) liver, not elsewhere classified
and
K75.81 – Nonalcoholic steatohepatitis (NASH).
The diagnosis selected should match the provider’s documented condition rather than being chosen according to which diagnosis is believed to produce better reimbursement.
For example, if the patient has documented fatty liver but has not been diagnosed with steatohepatitis, coding NASH simply to strengthen a claim would not be appropriate.
Hepatic Fibrosis Codes
When hepatic fibrosis has already been diagnosed, documentation should support its severity where known.
K74.00 – Hepatic fibrosis, unspecified
Use when hepatic fibrosis is established but the documented stage does not support a more specific available diagnosis.
K74.01 – Early hepatic fibrosis
This code describes early fibrosis within the applicable ICD-10-CM classification.
K74.02 – Advanced hepatic fibrosis
This code may be appropriate when advanced fibrosis is documented.
The distinction between these diagnoses is clinically significant and may affect medical-necessity review. Avoid automatically converting an elastography stiffness value into an ICD-10 fibrosis diagnosis without the responsible provider documenting the diagnosis.
Important FY 2027 ICD-10-CM Update: K74.0A
Providers should pay particular attention to an upcoming coding change.
CMS has released the FY 2027 ICD-10 files for services beginning October 1, 2026.
The new code:
K74.0A – Hepatic fibrosis, moderate fibrosis
is scheduled to become effective October 1, 2026. Published FY 2027 coding references identify the code with moderate or stage F2 hepatic fibrosis.
Because this guide is being prepared before that effective date, practices should not use K74.0A for dates of service before October 1, 2026.
That date-of-service distinction is easy to overlook when new diagnosis codes are loaded into an EHR or coding system before they officially become effective.
Chronic Viral Hepatitis and Liver Elastography
Patients with chronic viral hepatitis may also undergo elastography to assess fibrosis progression.
Potential diagnoses include:
| ICD-10-CM | Condition |
|---|---|
| B18.1 | Chronic viral hepatitis B without delta-agent |
| B18.2 | Chronic viral hepatitis C |
| B19.- | Unspecified viral hepatitis categories when documentation supports them |
The viral hepatitis diagnosis may explain the underlying liver disease while another code may identify documented fibrosis or cirrhosis.
Do not automatically report multiple liver diagnoses merely because they commonly occur together. Each submitted diagnosis should be supported in the chart.
Alcohol-Related Liver Disease
Fibrosis evaluation may also be performed in patients with alcohol-associated liver disease.
Potential ICD-10-CM categories include:
K70.2 – Alcoholic fibrosis and sclerosis of liver
K70.30 – Alcoholic cirrhosis of liver without ascites
K70.31 – Alcoholic cirrhosis of liver with ascites
Other K70 codes may apply depending on the documented condition.
CMS’s FY 2026 classification specifically includes alcoholic fibrosis, alcoholic cirrhosis, and related liver conditions within the hepatobiliary diagnosis group.
The precise diagnosis matters. “History of alcohol use” and “alcoholic cirrhosis” are not interchangeable coding concepts.
Other Liver Conditions That May Lead to Elastography
Depending on the patient’s condition and payer policy, liver stiffness assessment may also arise in patients with conditions such as autoimmune hepatitis, primary biliary disease, cholangitis, toxic liver disease, or other chronic hepatobiliary disorders.
Examples include:
K75.4 – Autoimmune hepatitis
K74.3 – Primary biliary cirrhosis
K83.01 – Primary sclerosing cholangitis
K71.7 – Toxic liver disease with fibrosis and cirrhosis of liver
The diagnosis should always be based on documented clinical findings rather than selected solely because it appears on a payer coverage list.
Can R74.01 Be Used for a FibroScan?
R74.01 – Elevation of levels of liver transaminase levels can be clinically relevant when a provider is investigating abnormal liver enzymes.
However, abnormal liver enzymes by themselves do not guarantee coverage for elastography.
The medical record should explain why fibrosis assessment is appropriate for that patient. For example, an abnormal ALT or AST combined with metabolic risk factors and documented suspected chronic liver disease creates a different clinical picture than a single transient laboratory abnormality.
Payer policy ultimately determines whether the submitted indications meet coverage requirements.
Choosing the Correct Diagnosis: A Practical Example
Consider a patient with long-standing fatty liver, type 2 diabetes, elevated ALT levels, and concern for progressive fibrosis.
The provider performs transient liver elastography to assess liver stiffness.
Depending on the established diagnoses in the record, the claim may involve:
CPT 91200 for the non-imaging transient elastography service;
K76.0 if fatty liver is the documented liver condition;
R74.01 if elevated transaminases are clinically relevant and documented;
and additional established conditions when they are relevant to the medical necessity of the test.
If the provider subsequently documents hepatic fibrosis based on the total clinical assessment, the appropriate K74 code may apply to subsequent care.
The test result itself should not lead administrative staff to independently diagnose the patient.
Modifiers for Liver Elastography
Modifiers should only be applied when the actual billing circumstances support them.
Modifier 26 – Professional Component
Modifier 26 identifies the professional component of certain diagnostic services when the physician provides the interpretation but does not bill the technical component.
It may be relevant to imaging-based procedures such as ultrasound or MR elastography when the service is appropriately divisible into professional and technical components.
Do not automatically append modifier 26 to every FibroScan claim.
Modifier TC – Technical Component
Modifier TC may identify the technical component of applicable diagnostic imaging services when the entity bills for equipment, technical staff, and related technical resources without reporting the professional interpretation.
Again, whether TC applies depends on the code and billing arrangement.
Modifier 59 – Distinct Procedural Service
Modifier 59 may sometimes be appropriate when two procedures that would ordinarily be bundled actually represent distinct services and documentation satisfies applicable coding rules.
It should never be added simply to force a claim through an edit.
CMS specifically warns that NCCI-associated modifiers such as 59 should only be used when the clinical circumstances genuinely justify bypassing an edit—for example, appropriately distinct encounters or services.
XE, XP, XS and XU
CMS recognizes the X{EPSU} modifiers as more specific alternatives to modifier 59 in appropriate situations:
XE – Separate encounter
XP – Separate practitioner
XS – Separate structure
XU – Unusual non-overlapping service
The correct modifier depends on what actually occurred and the payer’s requirements.
Can FibroScan and Abdominal Ultrasound Be Billed Together?
Sometimes a patient receives both elastography and a diagnostic abdominal ultrasound.
That does not automatically mean both services will be separately reimbursed.
The practice needs to determine whether the studies were independently medically necessary, whether each service was fully performed and documented, and whether current payer or NCCI edits permit separate payment.
Historical coding guidance has noted bundling relationships involving 91200 and abdominal ultrasound services, with separate-service modifiers potentially relevant when the services are genuinely distinct. Current NCCI and payer edits should be checked for the specific date of service rather than relying on old billing habits.
Documentation Required for FibroScan and Liver Elastography
Good coding starts with the procedure note.
A liver elastography record should make it possible for someone reviewing the claim months later to understand exactly why the study was performed and what service occurred.
Useful documentation generally includes the clinical indication, established or suspected liver condition, relevant laboratory or imaging findings, elastography technology used, anatomic area examined, quality of measurements, liver stiffness result, applicable additional measurements such as steatosis assessment when obtained, provider interpretation, and a dated report.
For 91200 in particular, the documentation should make clear that a non-imaging liver elastography procedure was performed.
Writing only:
“FibroScan done today”
leaves too many unanswered questions during an audit or appeal.
A stronger record connects the procedure to the patient’s liver disease and provides the measured findings and interpretation.
Common FibroScan and Liver Elastography Denials
Even technically correct procedure codes may deny when diagnosis linkage, authorization, documentation, or payer coverage is wrong.
CMS explains that remittance advice can communicate claim adjustments through a group code, a Claim Adjustment Reason Code (CARC), and, when applicable, a Remittance Advice Remark Code (RARC).
Here are several denial patterns practices should recognize.
CARC 50 – Medical Necessity
CARC 50 indicates that the payer considers the service non-covered because medical necessity requirements were not met. CMS uses this definition for medical-necessity adjustments.
For liver elastography, this can occur when the submitted diagnosis does not satisfy a payer’s coverage policy or documentation fails to demonstrate why fibrosis assessment was necessary.
What to review: diagnosis linkage, ordering note, liver disease history, relevant labs, previous imaging, and the payer’s applicable coverage policy.
CARC 16 – Missing Information
CARC 16 means information required to adjudicate the claim is missing.
The payer may pair this CARC with a remark code identifying what is missing.
What to review: diagnosis codes, referring provider information, required claim fields, procedure information, attachments, and other payer-specific requirements.
CARC 4 – Procedure/Modifier Problem
CARC 4 indicates that a procedure code conflicts with a modifier or that a required modifier is missing.
This is particularly relevant when professional and technical components of diagnostic imaging are being billed separately.
Do not simply add modifier 26, TC, or 59 after receiving the denial. First determine how the service was actually performed and which entity supplied each component.
CARC 11 – Diagnosis Inconsistent With Procedure
CARC 11 indicates that the submitted diagnosis is inconsistent with the procedure.
For elastography, this can point to poor diagnosis-to-procedure linkage.
A claim containing a liver elastography service but no diagnosis explaining the liver condition or clinical reason for fibrosis assessment may warrant careful review.
CARC 18 – Duplicate Service
CARC 18 identifies a duplicate claim or service.
This may occur when the same study is accidentally submitted twice or when corrected claims are transmitted incorrectly.
Verify the original claim before resubmitting.
CARC 97 – Included in Another Service
CARC 97 indicates that payment for the service is considered included in the allowance for another procedure.
This commonly points toward a bundling or coding-edit issue.
Check NCCI edits and payer-specific bundling rules before attempting to override the denial with modifier 59.
CARC 197 – Prior Authorization Missing
CARC 197 indicates that required precertification, authorization, notification, or pretreatment requirements were absent.
Not every payer requires authorization for liver elastography, but requirements differ considerably among commercial plans.
Eligibility verification alone does not confirm authorization requirements.
What About RARC Codes?
A RARC does not replace the CARC. Instead, it may provide additional information explaining an adjustment.
CMS notes that CARCs, RARCs, and group codes work together on electronic and paper remittance advice to explain how a claim was adjudicated.
Because the RARC paired with an elastography denial depends on the payer and exact claim issue, providers should not maintain a simplistic rule such as:
91200 denial always equals one particular RARC.
It does not.
The correct workflow is to read the CARC, accompanying RARC, payer policy reference, and claim-level details together before deciding whether to correct, resubmit, appeal, or write off the service.
For example, an unpossessable claim involving invalid or incomplete information may be accompanied by MA130, which CMS has used to indicate that a claim contains incomplete or invalid information and must be corrected and resubmitted.
Why Claims for Liver Elastography Commonly Fail
In practice, many problems are preventable.
A provider performs a FibroScan correctly, but CPT 76981 is submitted even though no imaging elastography was performed.
Or the right CPT code is reported, but it is linked to an unrelated diagnosis.
Another claim may contain a valid liver condition but fail because authorization was required.
A fourth may include 91200 and another ultrasound service, but documentation does not support why both studies were separately necessary.
These issues have very different solutions. Treating every denial as a modifier problem usually creates more rework.
A Cleaner Billing Workflow for FibroScan
Before the patient arrives, verify coverage requirements for the planned elastography technique.
At the time of service, confirm which technology was actually used rather than assuming the scheduled procedure and performed procedure are identical.
The physician’s documentation should state the clinical reason for testing and include an interpretation.
Before claim submission, match the CPT code to the performed technique and link it only to diagnoses supported by the chart.
Finally, check current payer policy and relevant coding edits.
CMS specifically notes that local Medicare coding information is often found in Billing and Coding Articles associated with MAC coverage policies, and providers can search by CPT or ICD-10-CM code to determine whether local requirements apply.
How Professional Billing Support Can Help
Elastography claims look simple because the procedure itself may take only a short time. The billing behind the service can be considerably less straightforward.
Small differences—non-imaging versus imaging elastography, fibrosis stage, modifier usage, authorization requirements, diagnosis linkage, or a payer-specific edit—can determine whether a claim is paid or returned.
NYC Medical Billing can help healthcare providers review coding workflows, payer requirements, claim submission, denial follow-up, and reimbursement issues related to diagnostic services such as liver elastography. The goal should not be to add codes simply to increase payment, but to make sure the claim accurately reflects the documented service.
Final Takeaway
Correct liver elastography billing depends on three pieces of the claim telling the same clinical story: what procedure was performed, why it was performed, and what the provider documented.
For conventional non-imaging transient elastography, CPT 91200 is the central code to understand. Imaging-based ultrasound elastography may instead fall under 76981, lesion-focused studies may involve 76982–76983, and MR elastography is represented by 76391.
The diagnosis must then reflect the patient’s actual liver condition—whether that is fatty liver, steatohepatitis, viral hepatitis, hepatic fibrosis, cirrhosis, or another documented indication.
Providers should also watch the ICD-10-CM transition on October 1, 2026, when the FY 2027 code set takes effect and K74.0A becomes available for documented moderate hepatic fibrosis.
For practices struggling with medical-necessity edits, incorrect procedure selection, modifier issues, authorization denials, or repeated elastography claim rejections, NYC Medical Billing can support a cleaner revenue-cycle process while keeping coding tied to the provider’s documentation and applicable payer rules.
Frequently Asked Questions
What is the CPT code for FibroScan?
CPT 91200 is generally associated with non-imaging liver elastography such as vibration-controlled transient elastography. Confirm the actual technology used before assigning the code.
Is CPT 76981 the same as FibroScan CPT 91200?
No. CPT 91200 describes non-imaging liver elastography, while CPT 76981 represents ultrasound elastography of organ parenchyma using imaging.
What ICD-10 code should be used with CPT 91200?
There is no single required diagnosis for every 91200 claim. The ICD-10-CM code should represent the documented condition or clinical reason for the study and must satisfy the applicable payer’s coverage criteria.
Potential diagnoses include K74.00, K74.01, K74.02, K75.81, K76.0, chronic viral hepatitis codes, alcohol-associated liver disease codes, and other documented chronic liver conditions.
Can K76.0 be used with FibroScan?
K76.0 identifies fatty change of liver and may be relevant when fatty liver is documented. Whether it supports coverage for CPT 91200 depends on the payer’s policy and the patient’s clinical circumstances.
Can abnormal liver enzymes support liver elastography?
R74.01 describes elevated liver transaminase levels and may form part of the clinical picture, but an abnormal laboratory result does not guarantee coverage. Documentation should demonstrate why evaluation for fibrosis is medically necessary.
Does a FibroScan result automatically establish hepatic fibrosis?
No. Test results should be interpreted in the patient’s complete clinical context. Administrative staff should not independently convert a stiffness measurement into an ICD-10 fibrosis diagnosis unless the responsible provider documents that diagnosis.
Is prior authorization required for CPT 91200?
Requirements vary by payer and health plan. Verify benefits and authorization requirements before the study whenever possible.
Can modifier 59 be added when CPT 91200 denies as bundled?
Only when the underlying circumstances satisfy applicable coding requirements for a genuinely distinct service. CMS cautions that modifier 59 and related NCCI-associated modifiers should not be used simply to bypass an edit.