CPT 78111Radiology

Plasma volume multiple

CPT code 78111 is used when a nuclear medicine physician performs multiple measurements of blood plasma volume using radioactive tracers to assess a patient's total blood volume status.

Showing rates for

National Average

Base Medicare rate

$88.95

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

0.22

PE RVU (NF)

2.48

MP RVU

0.05

Total RVU

2.75

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

NCCI bundling edits

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Billing tips

Verify that documentation specifies 'multiple' plasma volume determinations with at least two separate measurements documented at different time points
Impact: Prevents downcoding to 78110 (single study) which reimburses lower; ensures full $88.95 payment
Document the specific radiopharmaceutical used (I-125 albumin, I-131 albumin, or Cr-51) and total dose administered
Impact: Meets mandatory nuclear medicine documentation requirements; reduces audit risk and prevents denials
Bill global service (no modifier) when performed in non-facility setting where practice owns equipment and provides interpretation
Impact: Captures full $88.95 reimbursement versus split payment with 26/TC modifiers
Ensure timing and methodology of multiple measurements are clearly documented in medical record before claim submission
Impact: Justifies 78111 versus 78110; critical for appeals if payer requests records during pre-payment review
Verify medical necessity documentation includes specific indication requiring multiple measurements rather than single determination
Impact: Supports coverage determination; prevents medical necessity denials which constitute 35-40% of nuclear medicine denials
Check that radiation safety documentation and patient consent forms are complete and filed before billing
Impact: Required for compliance; missing documentation can trigger payment recoupment during post-payment audits

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78111 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78111 is $88.95 for both facility and non-facility settings, with a total RVU of 2.75 (Work RVU: 0.22, PE RVU: 2.48, MP RVU: 0.05).

What is the difference between CPT 78110 and 78111?

CPT 78110 covers a single plasma volume determination while 78111 covers multiple plasma volume determinations performed during the same encounter. Code 78111 requires documentation of at least two separate measurements at different time points and is used when serial assessments are medically necessary.

How many plasma volume measurements are required to bill CPT 78111?

At minimum, two separate plasma volume determinations at different time points are required to bill CPT 78111. Documentation must clearly show multiple measurements with distinct sampling times and calculated results for each measurement.

Can CPT 78111 be billed with modifier 26 for professional component only?

Yes, modifier 26 can be appended to CPT 78111 when billing only the professional component (physician interpretation) in settings where the technical component is billed separately by the facility. This splits the reimbursement between technical and professional services.

What radiopharmaceuticals are used for CPT 78111 plasma volume studies?

Common radiopharmaceuticals for plasma volume determination include radioiodinated human serum albumin (I-125 or I-131 labeled) and chromium-51 labeled albumin. The specific agent, dose, and administration time must be documented in the medical record.

Does CPT 78111 include red blood cell volume measurement?

No, CPT 78111 only includes plasma volume determinations. Red blood cell volume studies are reported separately using CPT 78120 (single determination) or 78121 (multiple determinations). Total blood volume studies combining both may require multiple codes with appropriate modifiers.

What documentation is needed to support medical necessity for CPT 78111?

Documentation must include the clinical indication requiring multiple plasma volume measurements (such as polycythemia evaluation, complex fluid management, or pre-surgical assessment), explanation of why a single determination is insufficient, and how results will guide treatment decisions. The physician's interpretation should correlate findings with clinical context.