CPT 78140Radiology

Red cell sequestration

CPT code 78140 is a nuclear medicine test that tracks where red blood cells are being destroyed in the body, typically in the spleen or liver. This test helps doctors diagnose conditions causing abnormal breakdown of red blood cells.

Showing rates for

National Average

Base Medicare rate

$106.10

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

0.61

PE RVU (NF)

2.62

MP RVU

0.05

Total RVU

3.28

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

NCCI bundling edits

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Billing tips

Verify separate billing of radiopharmaceutical using appropriate HCPCS codes (A9512 for Tc-99m pertechnetate, A9552 for In-111 oxyquinoline) as these are not included in the CPT 78140 reimbursement
Impact: Additional $150-$400 reimbursement depending on radiopharmaceutical used and dosage administered
Document serial imaging time points (typically at 30 minutes, 1 hour, 2 hours, and 24 hours) to support medical necessity and differentiate from simple organ imaging
Impact: Prevents downcoding to basic spleen scan (78185) which reimburses approximately $50 less
Bill technical and professional components separately when physician providing interpretation is different from facility providing equipment/staff to maximize compliant reimbursement
Impact: Ensures both entities receive appropriate payment; global billing when split services performed results in 40-50% payment reduction to one party
Include diagnosis codes specific to hemolytic conditions (D58.x, D59.x series) rather than generic anemia codes to support medical necessity
Impact: Reduces denial rate by approximately 25-30% based on LCD requirements for nuclear medicine studies
Submit prior authorization documentation for non-Medicare payers as many commercial plans require pre-certification for nuclear medicine procedures
Impact: Prevents denial and delayed payment; non-authorized claims may result in complete denial of $106.10 payment
Verify that both the cell labeling procedure and imaging sequences are documented separately in the medical record to support the complete procedure
Comprehensive documentation prevents partial payment or requests for refund during post-payment audits

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78140 in 2025?

The 2025 Medicare national average payment for CPT 78140 is $106.10 for both facility and non-facility settings. This is based on 3.28 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

How many RVUs is CPT code 78140 worth?

CPT 78140 has 3.28 total RVUs for 2025, consisting of 0.61 work RVUs, 2.62 practice expense RVUs, and 0.05 malpractice RVUs. These values are the same for both facility and non-facility settings.

Can CPT 78140 be billed with modifier 26 for professional component only?

Yes, CPT 78140 can be split into professional and technical components. Use modifier 26 for physician interpretation only, or modifier TC for the technical component (equipment, radiopharmaceutical, staff). The facility bills TC while the interpreting physician bills with modifier 26.

What diagnosis codes support medical necessity for CPT 78140?

Appropriate diagnosis codes include hemolytic anemias (D58.x for hereditary conditions, D59.x for acquired hemolytic anemias), splenomegaly (R16.1), hypersplenism (D73.1), and specific conditions like hereditary spherocytosis (D58.0) or autoimmune hemolytic anemia (D59.1). Generic anemia codes often result in denials.

Is radiopharmaceutical included in CPT 78140 reimbursement?

No, radiopharmaceuticals are billed separately using HCPCS codes. Common radiopharmaceuticals for red cell sequestration include A9512 (Tc-99m pertechnetate) or A9552 (In-111 oxyquinoline). These must be billed in addition to CPT 78140 for complete reimbursement.

How often can CPT 78140 be billed for the same patient?

Frequency depends on clinical necessity and payer policy. Medicare does not have a specific frequency limitation, but medical necessity must be documented for each study. Repeat studies within 30 days typically require additional documentation justifying clinical need, such as pre/post-treatment monitoring or inconclusive initial results.

What is the difference between CPT 78140 and 78185?

CPT 78140 (red cell sequestration) involves labeling the patient's red blood cells and performing serial imaging to track destruction sites, while 78185 is a simple spleen imaging study. Code 78140 is more complex, requires cell labeling, serial time points, and quantitative analysis, making it appropriate for evaluating hemolytic disorders rather than just anatomic spleen assessment.