CPT 78258Radiology

Esophageal motility

CPT code 78258 covers a nuclear medicine test that evaluates how well your esophagus moves food and liquid from your mouth to your stomach. This non-invasive imaging study uses a small amount of radioactive material to track swallowing function.

Showing rates for

National Average

Base Medicare rate

$190.52

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)

5.08

MP RVU

0.07

Total RVU

5.89

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

NCCI bundling edits

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Billing tips

Bill as global service when both technical and professional components are performed by same entity; split bill with 26/TC modifiers only when components are truly separate
Impact: Avoiding unnecessary modifier use prevents 10-15% payment reductions from incorrect component billing
Document medical necessity with specific symptoms (dysphagia grade, frequency, weight loss) and failed conservative treatments before ordering study
Impact: Strong medical necessity documentation reduces denial rate from approximately 25% to under 5% for this code
Verify prior authorization requirements before scheduling; many Medicare Advantage and commercial payers require pre-authorization for nuclear medicine studies
Impact: Pre-authorization compliance prevents 100% payment denial ($190.52 write-off per case)
Code separately for gastric emptying studies (78264) when performed in conjunction with esophageal motility if both are medically necessary and documented
Impact: Captures additional $200-300 in reimbursement when appropriately billed with modifier 59
Ensure radiotracer administration, imaging protocol details, and transit time measurements are explicitly documented in the final report
Impact: Detailed technical documentation reduces audit recoupment risk and supports the 5.08 practice expense RVU component
Submit claims within 30 days of service and include ordering physician NPI to prevent coordination of benefits delays
Impact: Timely filing with complete data reduces payment delays by 15-20 days on average

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78258 in 2025?

The 2025 Medicare national average payment rate for CPT 78258 is $190.52 for both facility and non-facility settings. This rate is based on 5.89 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

How does CPT 78258 differ from esophageal manometry?

CPT 78258 is a nuclear medicine imaging study that visualizes esophageal transit using radioactive tracers to measure how food moves through the esophagus. Esophageal manometry (CPT 91010/91013) measures pressure and muscular contractions. The nuclear study provides functional transit data while manometry provides pressure data; they are complementary tests often used together for complete motility assessment.

Can CPT 78258 be billed with modifier 26 or TC?

Yes, CPT 78258 can be split into professional (modifier 26) and technical (modifier TC) components when these services are provided by different entities. The global code should be used when the same provider performs both components. Splitting components when not appropriate can result in reduced reimbursement and audit findings.

What diagnosis codes support medical necessity for CPT 78258?

Common supporting ICD-10 codes include R13.10 (dysphagia), K22.0 (achalasia), K22.4 (dyskinesia of esophagus), K21.9 (GERD), M34.81 (systemic sclerosis with esophageal involvement), and R07.9 (chest pain when esophageal origin suspected). Documentation must clearly link the diagnosis to symptoms warranting nuclear medicine evaluation.

Is prior authorization required for CPT code 78258?

Prior authorization requirements vary by payer. Traditional Medicare typically does not require prior authorization, but Medicare Advantage plans frequently do. Most commercial payers require pre-authorization for nuclear medicine studies. Always verify specific payer requirements before scheduling to avoid denial of the $190.52 payment.

What are the work RVUs for CPT 78258?

CPT 78258 has a work RVU of 0.74, practice expense RVU of 5.08 (both facility and non-facility), and malpractice RVU of 0.07, totaling 5.89 RVUs. The relatively low work RVU reflects interpretation time, while the high practice expense RVU reflects equipment, radiotracer costs, and technologist time.

Can CPT 78258 be billed on the same day as gastric emptying studies?

Yes, CPT 78258 (esophageal motility) can be billed with gastric emptying studies (CPT 78264) on the same day when both are medically necessary and documented. Use modifier 59 on the secondary procedure to indicate they are distinct services. Combined esophageal and gastric transit studies are commonly performed together for comprehensive upper GI motility assessment.