CPT 78102Radiology

Bone marrow imaging ltd

CPT 78102 covers limited bone marrow imaging using radioactive tracers to visualize a specific area of bone marrow activity, typically to assess blood cell production or detect abnormalities in a targeted region.

Showing rates for

National Average

Base Medicare rate

$154.29

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

0.55

PE RVU (NF)

4.16

MP RVU

0.06

Total RVU

4.77

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

NCCI bundling edits

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Billing tips

Clearly document the specific anatomical region imaged to justify 'limited' designation versus whole-body study (78104)
Impact: Prevents upcoding audits and denials; maintains full $154.29 reimbursement versus risk of complete denial or investigation
Ensure both imaging and professional interpretation are completed on the same date of service for global billing
Impact: Avoids claim splits and administrative denials; ensures single clean claim payment of $154.29
Verify radiopharmaceutical administration is separately billable and not included in the imaging code
Impact: Additional revenue of $50-150 depending on specific radiopharmaceutical used (e.g., Tc-99m sulfur colloid)
Document medical necessity with specific clinical indication beyond screening, including relevant lab values or prior imaging findings
Impact: Reduces denial rate by 60-70% for medical necessity; most common reason for initial denials on this code
Bill facility versus non-facility rates appropriately based on practice setting; both are $154.29 for 2025
Impact: While rates are equal for 78102, proper place of service coding prevents future audits and ensures compliance
Use modifier 26 or TC only when professional and technical components are truly separated between different entities
Impact: Improper modifier use can trigger 10-20% payment reductions or complete denials requiring appeals

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78102 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78102 is $154.29 for both facility and non-facility settings. This is based on a total RVU of 4.77 multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 78102 and 78104 for bone marrow imaging?

CPT 78102 is used for limited bone marrow imaging of a specific anatomical region, while 78104 covers imaging of multiple areas or a more extensive examination. The limited study (78102) focuses on a targeted area based on specific clinical suspicion, whereas 78104 involves broader assessment of marrow distribution.

Can CPT 78102 be billed with modifier 26 for professional component only?

Yes, modifier 26 can be appended to 78102 when billing only the professional component (physician interpretation) separately from the technical component. This is common when the imaging is performed at a hospital or facility that bills separately for the technical resources.

What are the RVU values for CPT code 78102 in 2025?

CPT 78102 has a work RVU of 0.55, non-facility PE RVU of 4.16, facility PE RVU of 4.16, and malpractice RVU of 0.06, for a total RVU of 4.77 in 2025.

What documentation is required to bill CPT 78102 without denial?

Required documentation includes a physician order with specific clinical indication, radiopharmaceutical administration details, designation of the specific limited anatomical region imaged, complete imaging protocol with technical parameters, and a physician interpretation report establishing medical necessity and clinical correlation.

Which medical specialties typically bill CPT code 78102?

CPT 78102 is primarily billed by nuclear medicine physicians, diagnostic radiologists with nuclear medicine training, and facility-based hematology/oncology departments. The service must be performed under appropriate supervision by certified nuclear medicine or radiology professionals.

How often does Medicare deny claims for CPT 78102 and why?

Medical necessity denials are the most common issue with 78102, typically occurring when clinical indication is not clearly documented or diagnosis codes don't support the imaging. Other frequent denials include insufficient documentation distinguishing limited from whole-body studies and improper use of component modifiers (26/TC).