CPT 78226Radiology

Hepatobiliary system imaging

CPT 78226 covers hepatobiliary imaging, a nuclear medicine scan that uses a radioactive tracer to evaluate the liver, gallbladder, bile ducts, and small intestine. This test helps diagnose gallbladder disease, bile duct obstruction, and liver function problems.

Showing rates for

National Average

Base Medicare rate

$281.41

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

0.74

PE RVU (NF)

7.88

MP RVU

0.08

Total RVU

8.7

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Bill globally (without modifier) only when same entity owns equipment and provides professional interpretation
Impact: Receives full $281.41 payment; incorrect splitting when not applicable can trigger audits and recoupment
Document exact timing of imaging sequences (0-5 min, 30 min, 60 min, 90 min) in report to support full study completion
Impact: Prevents modifier 52 payment reductions; incomplete timing documentation can reduce payment 30-50%
When administering CCK or morphine for gallbladder ejection fraction, bill separately with appropriate drug codes (A9699, J2275)
Impact: Captures additional $15-45 in pharmaceutical reimbursement beyond the $281.41 imaging fee
Verify medical necessity documentation includes specific indication (e.g., 'acute cholecystitis suspected' not just 'abdominal pain') before billing
Impact: Reduces denial rate by approximately 25%; vague indications are primary denial reason for this code
For delayed imaging beyond 90 minutes, document medical necessity for extended imaging protocol in interpretation
Impact: Supports full payment despite extended time; undocumented delays may trigger review and modifier 52 application
When billing with ultrasound same day, ensure separate documentation justifies both studies or use modifier 59 appropriately
Impact: Prevents bundling denials; maintains separate $281.41 payment plus ultrasound reimbursement

Common denials

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 78226?

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 Medicare reimbursement rate for CPT 78226 in 2025?

The 2025 Medicare national average payment for CPT 78226 is $281.41 for both facility and non-facility settings. This rate is based on 8.7 total RVUs (0.74 work RVU, 7.88 PE RVU, 0.08 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 78226 be billed with an abdominal ultrasound on the same day?

Yes, but documentation must support medical necessity for both studies as distinct services. Append modifier 59 to the hepatobiliary scan when billing with ultrasound (76700, 76705) to indicate the HIDA scan provided functional information not available from anatomic ultrasound imaging. Many payers require documentation that ultrasound was equivocal or showed specific findings requiring functional assessment.

What documentation is required to bill CPT 78226 without denials?

Required documentation includes the radiopharmaceutical type and dose, injection time, sequential imaging times, gallbladder visualization status with timing, hepatic function assessment, biliary-to-bowel transit documentation, clinical indication with objective findings (not just 'abdominal pain'), any pharmacologic interventions used, and board-certified physician interpretation with signature.

How do I bill for CCK administration during a hepatobiliary scan?

CCK (sincalide) administration for gallbladder ejection fraction is billed separately from CPT 78226 using HCPCS code A9699 (radiopharmaceutical, therapeutic, not otherwise classified) or J2275 (morphine sulfate, up to 10 mg) if morphine is used instead. Document the drug name, dose, timing, and medical necessity in the procedure report. The imaging interpretation remains CPT 78226.

What are the Work RVUs for CPT code 78226?

CPT 78226 has 0.74 work RVUs in 2025, representing the physician work involved in performing and interpreting hepatobiliary scintigraphy. The total RVU is 8.7, which includes 7.88 practice expense RVUs and 0.08 malpractice RVUs.

When should I use modifier 26 vs TC with CPT 78226?

Use modifier 26 (professional component) when the physician only interprets images acquired at a separate facility. Use modifier TC (technical component) when the facility provides equipment, staff, and radiopharmaceuticals but an outside physician interprets. Bill without modifiers (global) only when the same entity provides both technical services and professional interpretation.

What are common medical necessity denials for hepatobiliary imaging?

Common denials occur when indication lists only 'abdominal pain' without supporting clinical findings like elevated liver enzymes, positive Murphy's sign, fever, or equivocal ultrasound results. Medical necessity requires objective clinical evidence suggesting biliary pathology. Appeals should include laboratory values, physical exam findings, prior imaging results, and reference to LCD criteria specifying that functional biliary assessment was clinically indicated.