CPT 78191Radiology

Platelet survival study

CPT 78191 is the billing code for a platelet survival study, a nuclear medicine test that uses a small amount of radioactive material to track how long platelets (blood cells that help clotting) survive in your bloodstream. This specialized test helps doctors diagnose bleeding disorders and problems with platelet production or destruction.

Showing rates for

National Average

Base Medicare rate

$120.65

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)

3.06

MP RVU

0.06

Total RVU

3.73

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Bill 78191 as a global service unless there is a contractual split between technical and professional components
Impact: Ensures full $120.65 reimbursement rather than risking underpayment from incomplete component billing
Document all serial blood sampling dates and times (typically 5-10 samples over 7-10 days) with corresponding radioactivity measurements in the medical record
Impact: Prevents denials for insufficient documentation; serial sampling is inherent to the procedure and must be evident to justify the 3.73 RVU assignment
Include specific radiopharmaceutical used (Indium-111 oxine or Chromium-51) and dosage in documentation, as this is not separately billable under OPPS
Impact: Radiopharmaceutical cost is bundled into the $120.65 payment; separate billing will result in denial and potential compliance issues
Verify medical necessity by documenting failed or inconclusive conventional platelet studies and specific clinical questions that only platelet survival can answer
Impact: Reduces denial risk for this specialized test; many payers require prior authorization and clear justification beyond simple thrombocytopenia
Do not unbundle blood drawing, processing, or imaging components as these are included in the platelet survival study code
Impact: Attempting to bill venipuncture (36415) or blood handling separately will trigger bundling edits and delay payment of the primary $120.65 claim
Submit claims after the complete study is finished (typically 7-10 days post-injection), not on the day of radiopharmaceutical administration
Billing prematurely may result in requests for refund if the study is not completed; wait until final calculations are documented to ensure the 3.73 RVUs are earned

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 78191?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT 78191?

The 2025 Medicare national average reimbursement rate for CPT 78191 is $120.65 for both facility and non-facility settings. This is based on a total RVU of 3.73 multiplied by the 2025 conversion factor of 32.3465.

How many RVUs is CPT code 78191 worth in 2025?

CPT 78191 is assigned 3.73 total RVUs in 2025, consisting of 0.61 work RVU, 3.06 practice expense RVU (both facility and non-facility), and 0.06 malpractice RVU according to the CMS Medicare Physician Fee Schedule.

Can CPT 78191 be billed with a professional and technical component split?

Yes, CPT 78191 can be split using modifier 26 for the professional component (physician interpretation) and modifier TC for the technical component (equipment, radiopharmaceutical, staff). However, most facilities bill it globally without modifiers to receive the full $120.65 reimbursement.

What diagnosis codes support medical necessity for platelet survival studies?

Common supporting ICD-10 codes include D69.3 (immune thrombocytopenic purpura), D69.6 (thrombocytopenia, unspecified), D69.59 (other secondary thrombocytopenia), and D69.49 (other primary thrombocytopenia). Documentation must show that conventional platelet evaluation was insufficient and survival kinetics are necessary for treatment decisions.

How long does a platelet survival study take to complete?

A platelet survival study requires 7-10 days to complete from initial radiopharmaceutical administration through final blood sampling. Serial blood samples are typically collected at regular intervals (e.g., days 0, 1, 3, 5, 7, and sometimes 10) to calculate the platelet survival curve and half-life.

Is prior authorization required for CPT 78191 platelet survival studies?

Most commercial payers and Medicare Advantage plans require prior authorization for CPT 78191 due to its specialized nature and cost. Original Medicare typically does not require prior authorization but does require clear documentation of medical necessity. Always verify payer-specific requirements before scheduling.

What is the difference between CPT 78190 and 78191?

CPT 78190 represents a kinetic study of red blood cell survival, while CPT 78191 is specifically for platelet survival studies. These are distinct procedures using different radiolabeling techniques and addressing different hematologic questions, so they should never be confused or substituted in billing.