CPT 78072Radiology

Parathyrd planar w/spect&ct

CPT 78072 covers advanced imaging of the parathyroid glands using a combination of planar nuclear medicine imaging with SPECT (3D imaging) and CT scan. This specialized test helps doctors locate abnormal parathyroid tissue that may be causing hormone imbalances.

Showing rates for

National Average

Base Medicare rate

$377.48

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

1.6

PE RVU (NF)

9.96

MP RVU

0.11

Total RVU

11.67

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

NCCI bundling edits

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Billing tips

Verify that all three components (planar, SPECT, and CT) are documented in the imaging report before billing 78072. If CT is not performed, downcode to 78071.
Impact: Prevents $100+ overpayment recovery and potential fraud allegations; 78071 reimburses significantly less than 78072
Document the radiopharmaceutical administration separately using CPT 79445 (therapeutic oral radiopharmaceutical) or appropriate A-code for the specific radiotracer used
Impact: Recovers additional $50-150 in reimbursement for radiopharmaceutical costs not included in 78072
Ensure interpretation includes specific localization findings (which gland, anatomic relationships to thyroid and vascular structures) to support surgical planning
Impact: Reduces audit risk and medical necessity denials; supports medical necessity for the higher-level code
Bill facility and non-facility rates correctly based on place of service; both rates are identical at $377.48 for 2025 due to high PE RVU equipment costs
Impact: Ensures accurate reimbursement; no financial difference but incorrect POS coding triggers audits
When performed on the same day as ultrasound (76536) or other parathyroid imaging, append modifier 59 to 78072 and document distinct clinical purpose
Impact: Prevents bundling denials; can preserve full $377.48 reimbursement when both studies are medically necessary
Check Medicare LCD policies for your MAC regarding coverage criteria for parathyroid imaging; some require specific PTH and calcium thresholds
Impact: Prevents medical necessity denials; pre-verification can identify coverage issues before performing $377.48 procedure

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 78072 in 2025?

The 2025 Medicare national average reimbursement for CPT 78072 is $377.48 for both facility and non-facility settings. This rate is based on 11.67 total RVUs multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 78071 and 78072?

CPT 78072 includes planar imaging with both SPECT and CT components, while 78071 includes planar imaging with SPECT only (no CT). The CT component in 78072 provides anatomic correlation for more precise localization of parathyroid adenomas. You must downcode to 78071 if CT is not performed.

Can you bill CPT 78072 with a thyroid scan on the same day?

Yes, but you must append modifier 59 to CPT 78072 to indicate it is a distinct procedural service from thyroid imaging codes (78013, 78014). Documentation must clearly support medical necessity for both separate studies, typically for preoperative parathyroid localization distinct from thyroid function assessment.

How many RVUs is CPT code 78072 worth in 2025?

CPT 78072 has 11.67 total RVUs in 2025, consisting of 1.6 work RVUs, 9.96 practice expense RVUs (both facility and non-facility), and 0.11 malpractice RVUs. This is a relatively high-value diagnostic imaging code.

Do I need prior authorization for CPT 78072?

Prior authorization requirements vary by payer and region. Many Medicare Advantage plans and commercial insurers require prior authorization for advanced imaging including SPECT/CT studies. Check with the specific payer before scheduling the procedure to avoid denial. Original Medicare typically does not require prior auth but does require medical necessity documentation.

What diagnosis codes support medical necessity for CPT 78072?

Primary ICD-10 codes include E21.0 (primary hyperparathyroidism), E21.1 (secondary hyperparathyroidism), E21.2 (other hyperparathyroidism), and E21.3 (hyperparathyroidism, unspecified). Supporting diagnoses include E83.52 (hypercalcemia) and associated renal calculi or bone density disorders. Documentation must include elevated calcium and PTH laboratory values.

Can CPT 78072 be billed with modifier 26 for professional component only?

Yes, use modifier 26 when billing only the physician interpretation component separately from the technical component. In split billing scenarios, the facility bills the TC modifier for equipment and staff costs, while the interpreting physician bills with modifier 26. The professional component represents approximately 13.7% of the total reimbursement.