CPT 78264Radiology

Gastric emptying imag study

CPT 78264 covers a gastric emptying study, a nuclear medicine test that tracks how quickly food leaves your stomach. The test helps diagnose conditions like gastroparesis (delayed stomach emptying) or dumping syndrome (too-rapid emptying).

Showing rates for

National Average

Base Medicare rate

$287.24

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

0.79

PE RVU (NF)

MP RVU

0.09

Total RVU

8.88

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

NCCI bundling edits

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Billing tips

Document exact imaging time points (0, 1, 2, 4 hours) and quantitative gastric retention percentages in the report to meet Medicare LCD requirements
Impact: Missing time-specific quantitative data is the leading cause of medical necessity denials, potentially costing the full $287.24 reimbursement
Verify the standardized meal composition meets consensus guidelines (egg white, bread, jam, water with Tc-99m sulfur colloid) and document meal contents
Impact: Non-standardized meals can result in study invalidation and claim denial; proper meal documentation supports 100% reimbursement
Bill split/shared visits (modifier FS) appropriately when hospital and private practice radiologist both participate in interpretation
Impact: Proper split billing ensures correct payment allocation between facility and professional components without duplicate payment issues
Check LCD requirements for your MAC regarding number of required imaging time points (typically minimum 3-4 time points required)
Impact: Insufficient imaging intervals may trigger downcoding or denial; meeting all protocol requirements protects full payment
Bundle gastric and small bowel transit when both are performed (use 78264 for gastric only; different code if combined study)
Impact: Incorrect code selection when performing combined studies can result in underpayment or overbilling compliance issues
Pre-authorize when required by payer and document medical necessity with specific symptoms and failed conservative management
Impact: Prior authorization denials account for approximately 15-20% of gastric emptying study rejections; obtaining approval upfront prevents $287.24 write-off

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78264 in 2025?

The 2025 Medicare national average reimbursement for CPT 78264 is $287.24 for both facility and non-facility settings. This rate is based on 8.88 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

How many RVUs is CPT code 78264 worth in 2025?

CPT 78264 has a total of 8.88 RVUs in 2025, consisting of 0.79 work RVUs, 8.0 practice expense RVUs (both facility and non-facility), and 0.09 malpractice RVUs. These values are from the CMS Physician Fee Schedule RVU25A released December 23, 2024.

Can CPT 78264 be billed with a professional component modifier?

Yes, CPT 78264 can be split into professional and technical components. Use modifier 26 for professional component (physician interpretation only) or modifier TC for technical component (equipment, staff, supplies). When split billing, ensure one entity bills TC and another bills 26 to equal the global service.

What diagnosis codes support medical necessity for CPT 78264?

Common supporting ICD-10 codes include K31.84 (gastroparesis), R11.2 (nausea with vomiting), K30 (functional dyspepsia), E11.43 (diabetic gastroparesis), and K91.1 (postgastric surgery syndromes). Documentation must show chronic symptoms, symptom severity affecting quality of life, and failed conservative management to establish medical necessity.

How often can CPT 78264 be billed for the same patient?

Frequency limitations vary by payer LCD policies, but typically gastric emptying studies are covered once every 6-12 months unless clinical change warrants earlier repeat. Document interim treatment changes, new symptoms, or therapeutic interventions when billing repeat studies. Use modifier 76 for same-day repeats due to technical issues.

What is the standard protocol for gastric emptying studies billed under 78264?

The consensus protocol requires a standardized low-fat meal (egg white sandwich with jam and water) labeled with Tc-99m sulfur colloid, with imaging at 0, 1, 2, and 4 hours post-ingestion. Patient must fast 4-6 hours before the study. Quantitative analysis must report gastric retention percentages at each time point. Deviation from this protocol may result in claim denials.

What is the difference between CPT 78264 and other gastric emptying codes?

CPT 78264 specifically covers gastric emptying imaging study with standardized meal. Related codes include 78265 (with small bowel transit), 78266 (with small bowel and colon transit), and 78267 (breath test for gastric emptying). Code selection depends on anatomical areas evaluated and methodology used. Billing the wrong code can result in downcoding or bundling denials.