CPT 78104Radiology

Bone marrow imaging body

CPT 78104 covers nuclear medicine imaging of bone marrow throughout the body to evaluate bone marrow function and distribution. This test helps doctors detect bone marrow disorders, infection, or abnormal blood cell production.

Showing rates for

National Average

Base Medicare rate

$218.02

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

0.8

PE RVU (NF)

5.87

MP RVU

0.07

Total RVU

6.74

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

NCCI bundling edits

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Billing tips

Bill the complete procedure as a single unit regardless of number of views or imaging time, as 78104 is inherently a whole-body study
Impact: Prevents unbundling denials and ensures receipt of full $218.02 reimbursement rather than partial payment
Separately bill for the radiopharmaceutical supply using appropriate A-codes or HCPCS codes in addition to 78104
Impact: Radiopharmaceutical costs can add $150-300 to total reimbursement; failure to bill separately results in significant revenue loss
When performed in a hospital outpatient setting, verify whether to bill globally or split between 26 and TC modifiers based on your contractual arrangement
Impact: Incorrect modifier usage can result in 40-60% underpayment or denial of the claim
Document specific clinical indication and medical necessity, particularly for patients without established hematologic malignancy, as many payers consider this a specialized study
Impact: Strong documentation reduces denial rate by approximately 30-40% for this procedure
Ensure delay imaging times (if performed) are documented but understand they are included in 78104 and should not be billed separately
Impact: Prevents unbundling denials and audit flags that could trigger recoupment of $218.02 plus penalties
Verify that bone marrow imaging (78104) is not billed on the same day as bone imaging (78300-78320 series) without appropriate modifier 59 and distinct documentation
Impact: Proper modifier usage preserves both payments; omission typically results in denial of one procedure ($200-400 loss)

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78104 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78104 is $218.02 for both facility and non-facility settings. This rate is based on 6.74 total RVUs multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 78104 and bone scan CPT codes?

CPT 78104 is specifically for bone marrow imaging to evaluate marrow function and distribution, typically using Tc-99m sulfur colloid. Bone scans (78300-78320) image the mineralized bone structure to detect fractures, metastases, or metabolic bone disease, typically using Tc-99m MDP. These are distinct procedures with different clinical indications and should not be confused.

Can CPT 78104 be billed with modifier 26 for professional component only?

Yes, modifier 26 can be appended to 78104 when billing only the physician interpretation component separately from the technical component. This is common when the imaging is performed at a hospital or imaging center that bills the technical component separately with modifier TC.

What are the work RVUs for CPT code 78104?

CPT 78104 has 0.8 work RVUs, 5.87 practice expense RVUs (both facility and non-facility), and 0.07 malpractice RVUs, totaling 6.74 RVUs for the complete procedure in 2025.

Does CPT 78104 require prior authorization from Medicare or commercial payers?

Medicare typically does not require prior authorization for 78104, but many commercial payers do require prior authorization for bone marrow imaging due to its specialized nature. Always verify payer-specific requirements before scheduling to avoid denials.

What diagnosis codes support medical necessity for CPT 78104?

Common supporting diagnosis codes include aplastic anemia (D61.x), myelofibrosis (D75.81), leukemia (C91.x-C95.x), lymphoma staging (C81.x-C85.x), fever of unknown origin (R50.9), and evaluation of bone marrow transplant status (Z94.81). Always verify current LCD/NCD requirements for your MAC.

How often can CPT 78104 be billed for the same patient?

There is no specific Medicare frequency limitation for 78104, but medical necessity must be documented for each study. Most payers expect reasonable intervals between studies (typically 30-90 days minimum) unless clinical status changes significantly. Repeat imaging within short intervals requires strong justification to avoid denial.