CPT 78015Radiology

Thyroid met imaging

CPT code 78015 covers specialized imaging to detect thyroid cancer that has spread (metastasized) to other parts of the body. This nuclear medicine scan uses radioactive tracers to locate thyroid cancer cells beyond the original thyroid gland.

Showing rates for

National Average

Base Medicare rate

$202.81

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

0.67

PE RVU (NF)

5.53

MP RVU

0.07

Total RVU

6.27

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

NCCI bundling edits

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Billing tips

Verify distinction between 78015 (metastasis imaging) and 78013 (thyroid imaging with uptake) - metastasis imaging is specifically for post-thyroidectomy cancer surveillance
Impact: Prevents $50-100 payment differential and reduces denial rate by 25-30% for inappropriate code selection
Document TSH stimulation method (thyroid hormone withdrawal vs. Thyrogen) and timing, as inadequate TSH elevation is a common medical necessity denial trigger
Impact: Reduces medical necessity denials by 40%; TSH level documentation supports $202.81 full reimbursement
Bill 78015 as global service (no modifier) when facility owns equipment and employs interpreting physician; split with 26/TC modifiers when components are separated
Impact: Ensures maximum reimbursement capture; improper modifier use can reduce payment by 30-50%
Coordinate billing with radioactive iodine administration code (79005) which is separately billable - do not bundle radiopharmaceutical costs into 78015
Impact: Captures additional $200-400 in legitimate separate reimbursement for therapeutic radioiodine when applicable
Document specific anatomic sites evaluated and any areas of abnormal uptake with SUV values or uptake percentages to support medical necessity and severity
Impact: Strengthens appeal success rate to 75-80% and supports potential additional imaging codes for targeted views
Verify patient preparation compliance (low iodine diet, medication withdrawal) in documentation as inadequate preparation can invalidate study and trigger denials
Prevents 15-20% of technical denials and supports medical necessity for any repeat imaging

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 78015 in 2025?

The 2025 Medicare national average reimbursement for CPT 78015 is $202.81 for both facility and non-facility settings. This rate is based on 6.27 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 78015 and 78013?

CPT 78015 is specifically for thyroid metastasis imaging performed after thyroidectomy to detect cancer spread, while 78013 is thyroid imaging with uptake measurements performed on an intact thyroid gland for diagnostic purposes (hyperthyroidism, nodules, etc.). Code selection depends on whether the thyroid has been surgically removed and whether the purpose is cancer surveillance versus initial thyroid function evaluation.

How often can CPT 78015 be billed for thyroid cancer surveillance?

Medicare typically covers 78015 based on clinical necessity rather than strict frequency limits. Standard surveillance protocols often include imaging at 6-12 months post-thyroidectomy, then annually or as clinically indicated based on risk stratification. More frequent imaging requires documentation of clinical changes such as rising thyroglobulin, new symptoms, or abnormal findings on other studies.

Can CPT 78015 be billed with modifier 26 for professional component only?

Yes, modifier 26 should be appended when billing only the physician interpretation component separately from the technical component. This is appropriate when a radiologist interprets images acquired at a separate facility. The technical component would be billed separately by the facility using modifier TC.

What diagnosis codes support medical necessity for CPT 78015?

Primary supporting ICD-10 codes include C73 (malignant neoplasm of thyroid gland), Z85.850 (personal history of malignant neoplasm of thyroid), and C79.xx codes for documented metastatic sites. Additional support comes from Z08 (encounter for follow-up exam after treatment for malignant neoplasm) and relevant codes for elevated tumor markers or abnormal thyroglobulin levels.

What are the RVUs for CPT code 78015 in 2025?

For 2025, CPT 78015 has a work RVU of 0.67, practice expense RVU of 5.53 (both facility and non-facility), and malpractice RVU of 0.07, totaling 6.27 RVUs. The practice expense represents the largest component due to expensive nuclear medicine equipment and radiopharmaceutical costs.

Does CPT 78015 include SPECT imaging or is that billed separately?

CPT 78015 includes planar whole-body imaging. If SPECT or SPECT/CT imaging is performed as part of the metastasis evaluation, codes 78830 or 78831 may be separately reportable with appropriate modifier 59 if distinct anatomic areas are evaluated or clinical circumstances justify both studies. Documentation must clearly support the medical necessity of additional imaging beyond standard planar views.