CPT 78075Radiology

Adrenal cortex & medulla img

CPT code 78075 covers nuclear medicine imaging of the adrenal glands, which sit on top of your kidneys and produce important hormones. This test uses radioactive tracers to create images of both the outer layer (cortex) and inner layer (medulla) of the adrenal glands.

Showing rates for

National Average

Base Medicare rate

$384.92

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

0.74

PE RVU (NF)

11.06

MP RVU

0.1

Total RVU

11.9

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

NCCI bundling edits

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Billing tips

Document which radiopharmaceutical(s) were used (MIBG, NP-59, etc.) and specify whether cortex, medulla, or both were imaged
Impact: Prevents $384.92 denials for insufficient specificity; payers often deny claims lacking radiopharmaceutical documentation
Bill the appropriate radiopharmaceutical supply code separately (A9590 for I-131 MIBG, A9508 for I-123 MIBG) in addition to 78075
Impact: Recovers additional $800-$2,500 in radiopharmaceutical costs that are not included in the $384.92 imaging reimbursement
When imaging spans multiple days (common with delayed MIBG imaging at 24, 48, and 72 hours), verify payer policy on multiple-day imaging billing
Impact: Some payers allow separate billing for each imaging session while others bundle into single 78075; can affect whether $384.92 is paid once or multiple times
Submit medical necessity documentation including relevant lab values (catecholamines, metanephrines, cortisol) and prior imaging findings with initial claim
Impact: Reduces denial rate by 40-60% and accelerates payment timeline by avoiding appeals process
Use modifier 26 or TC appropriately when splitting professional and technical components between facilities
Impact: Ensures accurate payment distribution; billing global when components split results in overpayment recovery demands
When billing with modifier 52 for single-component imaging (cortex only or medulla only), clearly document medical rationale
Impact: Supports reduced payment claims and prevents requests for refund if full bilateral imaging documentation is absent

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 78075 in 2025?

The 2025 Medicare national average reimbursement for CPT 78075 is $384.92 for both facility and non-facility settings. This rate is based on 11.9 total RVUs (0.74 work RVU, 11.06 PE RVU, 0.1 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

How much does adrenal gland imaging with CPT 78075 cost?

The Medicare allowable for 78075 is $384.92, but total cost including radiopharmaceutical can range from $1,200 to $3,000. Private insurance reimbursement typically ranges from 120-250% of Medicare rates. Patient out-of-pocket cost depends on insurance coverage, deductibles, and coinsurance, typically 10-20% after insurance.

Can CPT 78075 be billed with modifier 26 or TC?

Yes, CPT 78075 can be split into professional component (modifier 26 for interpretation only) and technical component (modifier TC for equipment/technologist/supplies). However, most facilities bill the global service. When components are split between entities, ensure only one bills global to avoid duplicate billing.

What diagnosis codes support medical necessity for CPT 78075?

Common supporting ICD-10 codes include D35.00-D35.02 (benign adrenal neoplasm), E27.5 (adrenomedullary hyperfunction), I15.2 (hypertension due to endocrine disorders), E24.9 (Cushing syndrome), and C74.00-C74.92 (malignant adrenal neoplasm). Document biochemical abnormalities and prior imaging findings to strengthen medical necessity.

How often can CPT 78075 be billed for the same patient?

Medicare does not have a specific frequency limit for 78075, but medical necessity must be documented for each study. Typical scenarios for repeat imaging include monitoring treatment response (6-12 month intervals), pre-operative localization, post-operative surveillance, or inadequate prior study. Requests more frequent than every 3-6 months face higher scrutiny.

What radiopharmaceuticals are used for CPT 78075 and how are they billed?

Common agents include I-131 MIBG (A9590) or I-123 MIBG (A9508) for adrenal medulla imaging, and I-131 NP-59 for adrenal cortex imaging. These radiopharmaceuticals are billed separately using HCPCS codes in addition to CPT 78075. The radiopharmaceutical cost ($800-$2,500) is separate from the $384.92 imaging reimbursement.

What are the most common reasons for denial of CPT 78075 claims?

Common denials include insufficient medical necessity documentation (lack of biochemical testing or prior imaging), missing radiopharmaceutical specification, bundling with other nuclear medicine procedures without appropriate modifiers, frequency limitations when repeat imaging lacks justification, and incomplete interpretation reports that don't address clinical indication.