CPT 78195Radiology

Lymph system imaging

CPT code 78195 covers lymphatic system imaging using radioactive tracers to visualize lymph nodes and vessels. This nuclear medicine scan helps diagnose lymphedema, detect lymph node abnormalities, and evaluate lymphatic drainage patterns.

Showing rates for

National Average

Base Medicare rate

$307.62

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

1.2

PE RVU (NF)

8.21

MP RVU

0.1

Total RVU

9.51

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

NCCI bundling edits

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Billing tips

Bill 78195 as a complete procedure including both radiopharmaceutical administration and imaging; do not separately bill for the injection procedure
Impact: Prevents unbundling denials and ensures full $307.62 reimbursement rather than reduced payment or complete denial
Document all imaging time points (immediate, 30 minutes, 1 hour, 2 hours, delayed) with specific timing and clinical rationale for each phase
Impact: Supports medical necessity and justifies 9.51 total RVUs; incomplete timing documentation causes 25-40% of denials
Verify coverage for lymphedema diagnosis codes (I89.0, I97.2) as many payers require specific ICD-10 codes and prior authorization
Impact: Prevents denials; lymphedema coverage varies significantly by payer with up to 60% denial rate without proper authorization
When performed for sentinel node identification, ensure diagnosis code reflects malignancy and surgical planning indication
Impact: Improves approval rate from 70% to 95% for oncology-related lymphatic mapping procedures
Split bill using modifier 26 and TC when physician reads study performed at different facility location
Impact: Ensures proper payment distribution; incorrect global billing causes payment delays averaging 45-60 days
Do not bill 78195 on same day as 38792 (injection for sentinel node identification) as injection is included in lymphoscintigraphy
Impact: Prevents automatic bundling denial and recoupment of $100-150 for the separately billed injection code

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78195 in 2025?

The 2025 Medicare national average reimbursement for CPT 78195 is $307.62 for both facility and non-facility settings. This rate is based on 9.51 total RVUs (1.2 work RVU, 8.21 practice expense RVU, 0.1 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 78195 be billed bilaterally or with a modifier 50?

CPT 78195 typically represents bilateral lymphatic imaging as a complete study and should not be billed with modifier 50. The procedure usually involves bilateral injection sites (both feet or both hands) with imaging of both sides included in the single code. Use RT/LT modifiers only when unilateral imaging is specifically performed due to clinical indication.

What diagnosis codes are typically used with CPT 78195?

Common diagnosis codes include I89.0 (lymphedema not elsewhere classified), I97.2 (postmastectomy lymphedema syndrome), Q82.0 (hereditary lymphedema), C77.x codes (secondary malignant neoplasm of lymph nodes) for sentinel node mapping, and R22.x codes (localized swelling) when lymphatic obstruction is suspected but not yet confirmed.

Does CPT 78195 include the radiopharmaceutical injection?

Yes, CPT 78195 includes the radiopharmaceutical administration as part of the complete procedure. Do not separately bill CPT 38792 (injection for sentinel lymph node identification) or other injection codes when performing lymphoscintigraphy, as this will result in bundling denials and potential recoupment.

How many RVUs is CPT 78195 worth in 2025?

CPT 78195 has a total of 9.51 RVUs in 2025, consisting of 1.2 work RVUs, 8.21 practice expense RVUs (both facility and non-facility), and 0.1 malpractice RVUs. The high practice expense RVU reflects the gamma camera equipment, radiopharmaceutical costs, and specialized technologist time required.

What modifiers are most commonly used with CPT 78195?

The most common modifiers are 26 (professional component only) and TC (technical component only) for split billing arrangements, modifier 59 for distinct procedural services when performed with other imaging, and modifier 52 for reduced services when the full protocol cannot be completed. RT/LT modifiers may be used for laterality documentation.

Is prior authorization required for CPT 78195?

Prior authorization requirements vary by payer but are increasingly common for CPT 78195, particularly for lymphedema indications. Medicare Advantage plans and commercial payers frequently require pre-authorization with documentation of conservative treatment failures, symptom duration, and objective measurements. Check specific payer policies before scheduling as retrospective denials are common without authorization.