CPT 78110Radiology

Plasma volume single

CPT code 78110 covers a nuclear medicine test that measures the total volume of plasma (the liquid portion of blood) in your body using a small amount of radioactive tracer. This test helps diagnose blood disorders, evaluate dehydration, and assess fluid balance in patients with heart or kidney problems.

Showing rates for

National Average

Base Medicare rate

$67.60

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

0.19

PE RVU (NF)

1.85

MP RVU

0.05

Total RVU

2.09

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

NCCI bundling edits

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Billing tips

Verify pre-authorization requirements before scheduling - most commercial payers require prior authorization for plasma volume studies despite Medicare not requiring it
Impact: Prevents denials that can delay payment by 30-60 days and may result in complete claim rejection if authorization not obtained
Bill globally (no modifier) when your facility owns equipment and employs both technical staff and interpreting physician to receive full $67.60 payment
Impact: Maximizes reimbursement by avoiding component billing which splits the total payment between professional and technical portions
Document the specific clinical indication (polycythemia workup, fluid balance assessment, pre-transplant evaluation) in both the order and interpretation report
Impact: Reduces medical necessity denials which account for approximately 25-30% of initial rejections for this code
When billing with red cell volume (78111), ensure documentation supports medical necessity for both tests as many payers consider plasma volume alone sufficient
Impact: Prevents bundling or denial of second study; combined studies when both medically necessary can yield $150+ in total reimbursement
Link to specific ICD-10 codes that support medical necessity: D45 (polycythemia vera), E86.0 (dehydration), E87.70 (fluid overload), D75.1 (secondary polycythemia)
Impact: Increases first-pass claim acceptance rate by 15-20% when specific diagnostic codes clearly justify the procedure
Report radiopharmaceutical supply separately using HCPCS codes (A9541 for Tc-99m, A9542 for I-131 albumin) for accurate reimbursement of materials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 78110 in 2025?

The 2025 Medicare national average reimbursement for CPT code 78110 (plasma volume single) is $67.60 for both facility and non-facility settings. This rate is based on 2.09 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustment factors for your specific area.

Does CPT 78110 require prior authorization from Medicare or commercial insurance?

Original Medicare typically does not require prior authorization for CPT 78110, but Medicare Advantage plans often do require pre-authorization. Most commercial payers require prior authorization for plasma volume studies due to the availability of alternative tests. Always verify authorization requirements with the specific payer before scheduling to avoid denials.

Can CPT 78110 and 78111 be billed together on the same date of service?

Yes, CPT 78110 (plasma volume) and 78111 (red cell volume) can be billed together when both are medically necessary, typically for complete blood volume determination or polycythemia vera workup. However, documentation must clearly justify the need for both tests, and modifier 59 may be required to prevent bundling. Some payers may deny one test as inclusive or unnecessary.

What diagnosis codes support medical necessity for CPT 78110?

Common ICD-10 codes supporting CPT 78110 include D45 (polycythemia vera), D75.1 (secondary polycythemia), E86.0 (dehydration), E87.70 (fluid overload), I50.9 (heart failure), and N18.9 (chronic kidney disease). The diagnosis must demonstrate why plasma volume measurement is necessary for diagnosis or treatment decisions when simpler tests like hematocrit or hemoglobin are insufficient.

What are the Work RVUs and total RVUs for CPT code 78110?

CPT code 78110 has a Work RVU of 0.19, Practice Expense RVU of 1.85 (both facility and non-facility), and Malpractice RVU of 0.05, for a total of 2.09 RVUs. This relatively low RVU value reflects the limited physician work involved, with most effort in the technical component of tracer preparation, injection, sampling, and calculations.

Who can perform and bill for CPT code 78110?

CPT 78110 must be performed under supervision of a physician certified in nuclear medicine or radiology with nuclear medicine training. The facility must hold appropriate radioactive material licenses from the NRC or Agreement State. Technical components require certified nuclear medicine technologists (CNMT or ARRT-N). Common billing specialties include nuclear medicine, radiology, hematology, and hospital-based departments.

How should modifier 26 and TC be used when billing CPT 78110?

Use modifier 26 when billing only the professional component (physician interpretation) if you don't own the equipment or employ technical staff. Use modifier TC when billing only the technical component (equipment, supplies, technologist) if interpretation is done by a separate physician. Bill without modifiers (globally) when your facility provides both components to receive the full $67.60 Medicare payment.