CPT 75801Radiology

Lymph vessel x-ray arm/leg

CPT 75801 covers an x-ray examination of the lymphatic vessels in an arm or leg, using contrast dye to visualize how lymph fluid moves through these vessels. This imaging test helps diagnose lymphedema, blockages, or abnormalities in the lymphatic system.

Showing rates for

National Average

Base Medicare rate

$41.40

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.81

PE RVU (NF)

0.34

MP RVU

0.13

Total RVU

1.28

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always append anatomic modifiers (LT/RT) to specify which extremity was studied, as this is required for Medicare and most commercial payers
Impact: Prevents automatic denial or request for medical records; claims without laterality modifiers may be rejected at initial submission
Document the specific lymphatic vessel cannulated and the volume/type of contrast used, as these details support the technical complexity and medical necessity
Impact: Reduces audit risk by 40-50% and strengthens appeals when medical necessity is questioned
Bill the contrast material separately using HCPCS code Q9965-Q9967 (depending on contrast type) when allowed by payer, as contrast is not included in the 75801 technical component
Impact: Can add $15-$45 per procedure depending on contrast volume and type used
Verify pre-authorization requirements before scheduling, as many payers require prior approval for lymphangiography due to its specialized nature and availability of alternative imaging
Impact: Pre-authorization failure is the leading cause of complete claim denial, resulting in $0 reimbursement and potential patient liability
When billing facility and professional components separately, ensure both claims include identical date of service, laterality modifier, and diagnosis codes
Impact: Mismatched claims trigger coordination of benefits edits and delay payment by 30-60 days on average
Link to diagnosis codes that clearly support medical necessity such as I89.0 (lymphedema), Q82.0 (hereditary lymphedema), or I97.2 (postmastectomy lymphedema syndrome) rather than nonspecific edema codes

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 75801 in 2025?

The 2025 Medicare national average payment rate for CPT 75801 is $41.40 for both facility and non-facility settings. This rate is based on 1.28 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic location based on local payment adjustments.

What is the difference between CPT 75801 and lymphoscintigraphy?

CPT 75801 is a direct contrast lymphangiography using x-ray imaging after surgical exposure and cannulation of a lymphatic vessel, while lymphoscintigraphy (CPT 78195) is a nuclear medicine study using radiotracer injection subdermally. Lymphangiography provides higher anatomic detail of lymphatic vessels but is more invasive, whereas lymphoscintigraphy is less invasive but provides functional information about lymphatic flow patterns.

Do I need modifier 26 or TC when billing CPT 75801?

Use modifier 26 if you are billing only for the professional interpretation component (physician reading). Use modifier TC if billing only for the technical component (equipment, supplies, staff). If you own the equipment and provide the interpretation, bill the code without a modifier for the global service. Split billing is common when hospital owns equipment but radiologist provides interpretation.

Is prior authorization required for CPT 75801?

Most Medicare Advantage plans and commercial insurers require prior authorization for CPT 75801 due to its specialized nature and the availability of less invasive alternatives. Traditional Medicare (Part B) does not require prior authorization but does require medical necessity documentation. Always verify specific payer requirements before scheduling the procedure to avoid claim denials.

Can CPT 75801 be billed bilaterally for both arms or both legs?

CPT 75801 is reported per extremity, so if lymphangiography is performed on both the right and left arm (or both legs), you would bill 75801 twice with modifier RT on one claim line and LT on the other. However, bilateral lymphangiography is extremely rare and would require exceptional documentation of medical necessity, as simultaneous bilateral studies face high scrutiny and frequent denials.

What diagnosis codes are typically used with CPT 75801?

Common ICD-10 codes supporting medical necessity for 75801 include I89.0 (lymphedema not elsewhere classified), Q82.0 (hereditary lymphedema), I97.2 (postmastectomy lymphedema syndrome), I89.1 (lymphangitis), and C77.x codes (secondary malignancy of lymph nodes). Nonspecific edema codes like R60.0 or R60.9 typically do not meet medical necessity criteria and result in denials.

How many RVUs is CPT code 75801 worth?

CPT 75801 has a total of 1.28 RVUs for 2025, broken down as: 0.81 work RVUs, 0.34 practice expense RVUs (both facility and non-facility), and 0.13 malpractice RVUs. These values are from the CMS Physician Fee Schedule RVU25A file released December 23, 2024.