CPT 78201Radiology

Liver imaging static only

CPT code 78201 covers a stationary nuclear medicine scan of the liver that captures images without tracking movement or blood flow. This test helps detect liver abnormalities, tumors, or diseases using radioactive tracers.

Showing rates for

National Average

Base Medicare rate

$169.82

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

0.44

PE RVU (NF)

4.75

MP RVU

0.06

Total RVU

5.25

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

NCCI bundling edits

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Billing tips

Verify that dynamic or blood flow phases were NOT performed; if blood flow or SPECT imaging was included, use 78215 or 78216 instead
Impact: Incorrect code selection results in underbilling (78215 pays $280+) or denials for code mismatch with documentation
Bill the radiopharmaceutical separately using appropriate HCPCS codes (A9540 for Tc-99m sulfur colloid) in addition to 78201
Impact: Radiopharmaceutical costs typically add $50-100 to total reimbursement and are separately payable
When performed in non-facility settings, ensure all 4.75 PE RVUs are captured by billing without modifier TC; split billing loses value
Impact: Non-facility rate of $169.82 applies to complete service; improper modifier use can reduce payment by 40-60%
Document exact radiopharmaceutical dose, uptake time, number of views, and reason static imaging is sufficient without dynamic phases
Impact: Prevents downcoding or denials; unclear documentation triggers medical review causing 30-45 day payment delays
Verify medical necessity is clearly documented when ordering provider is different from interpreting physician
Impact: Missing or inadequate orders account for 15-20% of denials; clear indication prevents $169.82 write-off
For Medicare patients, confirm the National Coverage Determination (NCD) and Local Coverage Determination (LCD) requirements for liver imaging are met
Impact: Non-covered indications result in complete denial; verifying coverage criteria prevents $169.82 loss per claim

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78201 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78201 is $169.82 for both facility and non-facility settings. This rate is based on 5.25 total RVUs (0.44 work RVU, 4.75 PE RVU, 0.06 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 78201 and 78215?

CPT 78201 is for static liver imaging only, capturing fixed images without blood flow or dynamic phases. CPT 78215 includes both vascular flow and static images of the liver. If any blood flow imaging was performed, 78215 is the correct code and reimburses at a higher rate than 78201.

Can CPT 78201 be billed with modifier 26 or TC?

Yes, CPT 78201 can be split into professional (modifier 26) and technical (modifier TC) components. This is common when a hospital owns the equipment (bills TC) and a separate physician group provides interpretation (bills 26). Without modifiers, the billing entity must provide both components.

How many RVUs is CPT code 78201 worth?

CPT 78201 has 5.25 total RVUs in 2025, consisting of 0.44 work RVUs, 4.75 practice expense RVUs (both facility and non-facility), and 0.06 malpractice RVUs according to the CMS Physician Fee Schedule.

What radiopharmaceutical is used for CPT 78201?

The most common radiopharmaceutical for CPT 78201 is technetium-99m sulfur colloid (HCPCS code A9540), though other Tc-99m labeled agents may be used. The radiopharmaceutical must be billed separately using the appropriate HCPCS code as it is not included in the 78201 reimbursement.

Does CPT 78201 require prior authorization from Medicare?

Prior authorization requirements vary by Medicare Administrative Contractor (MAC) and specific patient circumstances. While traditional Medicare does not universally require prior authorization for 78201, Medicare Advantage plans often do. Always verify with the specific payer and check Local Coverage Determinations before scheduling.

What diagnosis codes support medical necessity for CPT 78201?

Common supporting ICD-10 codes include R16.0 (hepatomegaly), R93.2 (abnormal liver imaging findings), K76.9 (liver disease unspecified), C78.7 (secondary malignancy of liver), and elevated liver enzyme codes. The specific diagnosis must match the clinical indication documented in the medical record and meet LCD criteria.