CPT 78215Radiology

Lvr&spleen img static only

CPT code 78215 covers nuclear medicine imaging of the liver and spleen using radioactive tracers to create static images that help identify abnormalities, enlargement, or damage to these organs.

Showing rates for

National Average

Base Medicare rate

$174.35

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

0.49

PE RVU (NF)

4.84

MP RVU

0.06

Total RVU

5.39

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

NCCI bundling edits

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Billing tips

Verify that documentation explicitly states 'static imaging only' and does not include dynamic flow phases or SPECT acquisition, which would require different CPT codes
Impact: Prevents upcoding denials and potential recoupment of the full $174.35 payment
Bill the complete code 78215 when both liver and spleen are imaged; do not attempt to bill separate organ studies if both organs are visualized in the static acquisition
Impact: Avoids unbundling denials and maintains correct $174.35 reimbursement rather than risking complete denial
Document the specific radiopharmaceutical used (typically Tc-99m sulfur colloid), dose administered, and time interval between injection and imaging
Impact: Meets radiopharmaceutical documentation requirements and supports medical necessity, reducing audit risk
When billing split/shared professional-technical components, ensure both 26 and TC modifiers are used correctly by respective billing entities to avoid duplicate payment issues
Impact: Prevents overpayment flags that can delay payment or trigger audits affecting the full $174.35 reimbursement
Confirm that the ordering physician's documentation supports medical necessity with specific clinical indication beyond 'hepatomegaly' - include suspected diagnosis such as cirrhosis, metastatic disease, or hemangioma
Impact: Strengthens LCD compliance and reduces likelihood of medical necessity denials that would forfeit entire payment
For hospital outpatient settings, verify that both hospital and physician billing are coordinated to prevent duplicate claims for the same service date

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78215 in 2025?

The 2025 Medicare national average reimbursement for CPT 78215 is $174.35 for both facility and non-facility settings, based on 5.39 total RVUs multiplied by the conversion factor of 32.3465.

Can CPT 78215 be billed for liver imaging only without the spleen?

No, CPT 78215 specifically describes combined liver and spleen imaging. If only the liver is imaged, you should use CPT 78201 for static liver imaging. Billing 78215 when only one organ is imaged constitutes incorrect coding and may result in denial or recoupment.

What is the difference between CPT 78215 and 78216?

CPT 78215 covers static imaging only of the liver and spleen, while CPT 78216 includes both vascular flow and static images. Code selection depends on whether dynamic flow imaging was performed in addition to static images. Documentation must clearly specify which imaging phases were acquired.

How many RVUs is CPT code 78215 worth?

CPT 78215 has 5.39 total RVUs for 2025, consisting of 0.49 work RVUs, 4.84 practice expense RVUs, and 0.06 malpractice RVUs. The facility and non-facility PE RVUs are identical at 4.84.

Do I need prior authorization for CPT 78215?

Prior authorization requirements vary by payer and state. Many Medicare Advantage plans and commercial insurers require prior authorization for nuclear medicine studies including 78215. Check specific payer policies before scheduling, as lack of authorization will result in claim denial despite medical necessity.

Can CPT 78215 be billed with modifier 26 for professional component only?

Yes, modifier 26 should be appended when billing only the physician interpretation component, typically in settings where the hospital or imaging center bills the technical component separately with modifier TC. The total reimbursement of $174.35 is split between professional and technical components.

What diagnosis codes support medical necessity for CPT 78215?

Common supporting ICD-10 codes include R16.0 (hepatomegaly), R16.1 (splenomegaly), K74.60 (unspecified cirrhosis), C78.7 (liver metastases), D18.03 (hemangioma of liver), and D73.89 (splenic disorders). Local Coverage Determinations may specify additional covered diagnoses, so verify payer-specific LCD requirements.