CPT 78231Radiology

Salivary glnd img serial img

CPT 78231 covers nuclear medicine imaging of the salivary glands using radioactive tracers to evaluate gland function and detect abnormalities like blockages, tumors, or Sjögren's syndrome.

Showing rates for

National Average

Base Medicare rate

$100.92

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

0.52

PE RVU (NF)

2.55

MP RVU

0.05

Total RVU

3.12

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

NCCI bundling edits

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Billing tips

Document specific time intervals for serial imaging acquisitions in the report (typically images at 5, 10, 20, and 30 minutes post-injection)
Impact: Serial imaging documentation is essential to justify 78231 versus simpler codes; missing timeframes can trigger $100.92 denial
Verify whether facility is billing global service or if professional/technical components should be split using 26/TC modifiers
Impact: Incorrect component billing can result in overpayment recoupment or underpayment; component splits vary by payer
Include lemon juice or citric acid stimulation timing and patient response in documentation when performed
Impact: Stimulation phase is integral to 78231; absence of documentation may downcode to unlisted procedure reducing reimbursement
Code 78231 once regardless of number of glands imaged bilaterally; this is not a per-gland code
Impact: Billing bilaterally or per gland will result in denial as incorrect units; confirms single $100.92 payment
Do not separately bill the radiopharmaceutical (A9512 for Tc-99m pertechnetate); it is included in the procedure code
Impact: Unbundling radiopharmaceutical risks compliance audit and recoupment of separate drug payment
When performed same day as other nuclear medicine studies, verify payer-specific bundling edits in NCCI before billing
Impact: Incorrect same-day billing without appropriate modifier 59 can delay payment 30-60 days pending review

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78231 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78231 is $100.92 for both facility and non-facility settings, based on 3.12 total RVUs and a conversion factor of 32.3465.

How many RVUs is CPT code 78231 worth?

CPT 78231 has 3.12 total RVUs in 2025, consisting of 0.52 work RVU, 2.55 practice expense RVU, and 0.05 malpractice RVU.

Can CPT 78231 be billed bilaterally with a modifier?

No, CPT 78231 is inherently bilateral and includes imaging of all salivary glands. It should be billed as a single unit regardless of how many glands are imaged, and bilateral modifiers (50, LT, RT) are not appropriate.

What is the difference between CPT 78230 and 78231?

CPT 78230 is a single static salivary gland image, while CPT 78231 involves serial/dynamic imaging with multiple image acquisitions over time to assess gland function, uptake, and excretion patterns. The serial component in 78231 provides functional information and justifies higher reimbursement.

Do I need to bill separately for the radiotracer used in salivary gland imaging?

No, the radiopharmaceutical (typically Tc-99m pertechnetate, HCPCS A9512) is bundled into CPT 78231 and should not be billed separately. Unbundling the drug code risks compliance violations and payment recoupment.

What diagnosis codes support medical necessity for CPT 78231?

Common supporting ICD-10 codes include M35.00-M35.09 (Sjögren's syndrome), K11.20-K11.9 (salivary gland diseases), R68.2 (dry mouth), K11.5 (sialolithiasis), and C07-C08 codes (salivary gland neoplasms). Documentation must clearly link the diagnosis to the imaging indication.

Should I use modifier 26 or TC when billing CPT 78231?

Use modifier 26 only when billing the professional component (physician interpretation) separately, typically in hospital settings where the facility bills the technical component with TC modifier. In private practice with owned equipment, bill globally without modifiers. Split billing must reflect actual ownership and service provision.