CPT 78185Radiology

Spleen imaging

CPT 78185 covers nuclear medicine imaging of the spleen using radioactive tracers to evaluate spleen size, position, and function. This specialized scan helps doctors diagnose conditions like spleen damage, abnormal spleen tissue, or accessory spleens.

Showing rates for

National Average

Base Medicare rate

$148.47

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

0.4

PE RVU (NF)

4.14

MP RVU

0.05

Total RVU

4.59

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 as many payers require prior approval for nuclear medicine studies including spleen imaging
Impact: Prevents denials averaging 100% payment loss ($148.47) due to lack of pre-authorization
Document specific radiopharmaceutical used (Tc-99m sulfur colloid vs heat-damaged RBCs) and dosage as Medicare contractors require this information for medical necessity review
Impact: Reduces medical necessity denials which account for 30-40% of nuclear medicine claim rejections
Bill global code 78185 only when same entity provides both technical and professional components; split with 26/TC modifiers when services are divided
Impact: Improper component billing results in overpayment recovery or underpayment by approximately 40-60% of allowed amount
Submit claims within timely filing limits (typically 365 days for Medicare, shorter for commercial payers) as nuclear medicine studies often have delayed billing
Impact: Timely filing denials result in 100% payment loss ($148.47) with extremely limited appeal rights
Link to specific ICD-10 codes indicating medical necessity such as D73.89 for accessory spleen evaluation or S36.039A for splenic injury rather than generic screening codes
Impact: Specific diagnosis coding reduces medical necessity denials by 25-35% compared to non-specific codes
Do not separately bill for radiopharmaceutical supply as this is included in the 78185 reimbursement; only the imaging procedure is billable
Impact: Prevents unbundling denials and compliance issues; radiopharmaceutical costs are included in the PE RVU of 4.14

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78185 in 2025?

The 2025 Medicare national average reimbursement for CPT 78185 is $148.47 for both facility and non-facility settings. This rate is based on 4.59 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

Can CPT 78185 be billed with a liver scan on the same day?

Generally no, unless documented as distinct procedures. If both liver and spleen imaging are needed, CPT 78215 (liver and spleen imaging) is typically the appropriate code. Bill 78185 separately with modifier 59 only when spleen-only imaging is performed at a different session or for a distinctly different clinical indication with clear documentation supporting separate medical necessity.

What diagnosis codes support medical necessity for spleen imaging CPT 78185?

Common supporting diagnoses include D73.89 (other diseases of spleen, including accessory spleen), S36.039A (unspecified laceration of spleen), D73.5 (infarction of spleen), Z90.81 (acquired absence of spleen), D73.1 (hypersplenism), and Q89.09 (congenital malformations of spleen). Always link the most specific diagnosis code that accurately reflects the clinical indication for imaging.

How long does spleen imaging CPT 78185 typically take to perform?

The complete procedure typically takes 60-90 minutes including radiopharmaceutical preparation and administration, waiting period for tracer uptake (usually 30-60 minutes), image acquisition (15-30 minutes), and processing. The work RVU of 0.4 reflects the physician interpretation time, not the total technical procedure time.

Is prior authorization required for CPT code 78185?

Prior authorization requirements vary by payer. Medicare Advantage plans and many commercial insurers require pre-authorization for nuclear medicine studies including spleen imaging. Traditional Medicare does not require prior authorization but does require medical necessity. Always verify requirements with the specific payer before scheduling to avoid denials.

What is the difference between CPT 78185 and 78215?

CPT 78185 is for spleen imaging only, while CPT 78215 covers combined liver and spleen imaging. Use 78185 when only splenic evaluation is clinically indicated (such as post-splenectomy evaluation for accessory spleen). Use 78215 when both liver and spleen assessment is needed. Billing both codes together is considered unbundling and will result in denials.

Does CPT 78185 include the radiopharmaceutical cost?

Yes, the reimbursement for CPT 78185 ($148.47) includes the radiopharmaceutical costs within the practice expense RVU component (4.14 PE RVU). Do not separately bill for Tc-99m sulfur colloid or other tracers used for spleen imaging. The all-inclusive payment covers technical services, supplies, equipment, and radiopharmaceuticals.