CPT 78013Radiology

Thyroid imaging w/blood flow

CPT code 78013 covers thyroid imaging with blood flow study, a nuclear medicine scan that uses radioactive tracers to evaluate thyroid function and visualize blood circulation to the thyroid gland.

Showing rates for

National Average

Base Medicare rate

$163.35

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

0.37

PE RVU (NF)

4.62

MP RVU

0.06

Total RVU

5.05

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

NCCI bundling edits

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Billing tips

Verify that documentation specifically describes the blood flow/dynamic vascular phase imaging, not just static thyroid images, as this differentiates 78013 from 78012
Impact: Prevents downcoding from 78013 ($163.35) to 78012, which reimburses approximately $30-40 less
Bill the radiopharmaceutical separately using HCPCS code A9512 or A9502 when appropriate, as the drug cost is not included in 78013 reimbursement
Impact: Recovers additional $50-150 in radiopharmaceutical costs that would otherwise be lost
Document the total imaging time and number of flow images acquired during arterial phase to support medical necessity and differentiate from routine static imaging
Impact: Reduces audit risk and supports the 5.05 total RVU assignment which includes the additional work of flow imaging
When billing split or shared between facility and professional components, ensure modifier 26 or TC is appended appropriately to prevent overpayment recoupment
Impact: Prevents overpayment recovery audits averaging $163.35 per incorrectly billed claim
Verify medical necessity documentation includes specific clinical indication for blood flow assessment, not just general thyroid imaging
Impact: Prevents denials for lack of medical necessity which account for 15-20% of initial claim rejections
Check payer LCD/NCD policies for thyroid imaging frequency limitations, as many payers restrict repeat studies within 90-180 days without clinical change
Impact: Avoids automatic denials and reduces days in AR by 30-45 days for repeat studies

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78013 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78013 is $163.35 for both facility and non-facility settings, based on 5.05 total RVUs and the 2025 conversion factor of 32.3465.

What is the difference between CPT 78013 and 78012?

CPT 78013 includes thyroid imaging with blood flow study (dynamic vascular imaging), while 78012 is thyroid imaging with uptake without blood flow. Code 78013 requires documentation of the dynamic arterial phase imaging to assess thyroid vascularity, which is not part of 78012.

Can CPT 78013 be billed with modifier 26 for professional component only?

Yes, modifier 26 can be appended to 78013 when billing only the professional component (physician interpretation) separately from the technical component, which is common when the imaging is performed at a facility but interpreted by an outside physician.

How many RVUs is CPT code 78013 worth in 2025?

CPT 78013 has 5.05 total RVUs in 2025, consisting of 0.37 work RVU, 4.62 practice expense RVU (both facility and non-facility), and 0.06 malpractice RVU.

What diagnosis codes support medical necessity for CPT 78013?

Common supporting ICD-10 codes include E05.00-E05.91 (thyrotoxicosis/Graves' disease), E04.1 (nontoxic single thyroid nodule), E06.1 (subacute thyroiditis), E04.2 (nontoxic multinodular goiter), and R94.6 (abnormal thyroid function studies) when vascular assessment is clinically indicated.

Is the radiopharmaceutical included in CPT 78013 reimbursement?

No, radiopharmaceutical costs are not included in CPT 78013 reimbursement and should be billed separately using appropriate HCPCS codes such as A9512 (Technetium Tc-99m pertechnetate) or A9502 (Technetium Tc-99m tetrofosmin).

How often can CPT 78013 be billed for the same patient?

Frequency depends on payer policy and medical necessity. Most Medicare contractors allow repeat thyroid imaging when there is documented clinical change, treatment failure, or new symptoms, but may deny studies repeated within 90-180 days without clear clinical justification.