CPT 78265Radiology

Gastric emptying imag study

CPT code 78265 covers a gastric emptying imaging study, which is a nuclear medicine test that tracks how quickly food leaves your stomach to diagnose digestive problems like gastroparesis or delayed gastric emptying.

Showing rates for

National Average

Base Medicare rate

$342.23

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

0.98

PE RVU (NF)

9.51

MP RVU

0.09

Total RVU

10.58

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

NCCI bundling edits

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Billing tips

Always document all four time points (0, 1, 2, and 4 hours) per ACG/ANMS consensus guidelines to meet medical necessity requirements and avoid downcoding
Impact: Missing time points can result in denial or reduction to a lesser code, potentially losing the full $342.23 reimbursement
Verify the radiotracer meal composition meets standardized protocols (typically egg whites labeled with Tc-99m) and document exact caloric content and preparation
Impact: Non-standardized meals may trigger medical necessity denials, resulting in 100% payment loss ($342.23)
Bill modifier 26 separately when providing only professional interpretation in hospital outpatient settings to capture appropriate physician work RVU of 0.98
Impact: Proper component billing can optimize revenue distribution; professional component typically represents approximately $85-$100
Ensure prior authorization is obtained when required by commercial payers, as gastric emptying studies are frequently subject to pre-certification requirements
Impact: Lack of prior authorization is the leading cause of denial, resulting in 100% write-off and significant appeal effort
Document medical necessity clearly by referencing specific symptoms (nausea, vomiting, early satiety) and duration, along with failed conservative management
Impact: Weak medical necessity documentation increases denial risk by 40-60% based on payer audit patterns
Do not bill 78265 on the same day as 78264 (gastric emptying imaging study, solid) unless procedures are truly distinct and modifier 59 is appropriately applied with separate documentation

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78265 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78265 is $342.23 for both facility and non-facility settings. This is based on a total RVU of 10.58 multiplied by the 2025 conversion factor of 32.3465.

How many RVUs is CPT code 78265 worth?

CPT 78265 has a total RVU value of 10.58, consisting of 0.98 work RVUs, 9.51 practice expense RVUs, and 0.09 malpractice RVUs based on the 2025 Medicare Physician Fee Schedule.

What is the difference between CPT 78264 and 78265?

CPT 78264 represents a gastric emptying imaging study with a solid meal only, while CPT 78265 includes imaging with both solid and liquid components or additional imaging parameters. Code 78265 is more comprehensive and should not be billed together with 78264 on the same date of service.

Does CPT 78265 require prior authorization?

Medicare does not typically require prior authorization for CPT 78265, but many commercial payers and Medicare Advantage plans do require pre-certification. Always verify authorization requirements with the specific payer before performing the procedure to avoid denials.

Can CPT 78265 be billed with modifier 26?

Yes, CPT 78265 can be billed with modifier 26 for the professional component when a physician provides only the interpretation and report but does not own the equipment. The technical component would be billed separately with modifier TC by the facility providing the equipment and technical staff.

What diagnosis codes support medical necessity for CPT 78265?

Common ICD-10 codes supporting CPT 78265 include K31.84 (gastroparesis), R11.2 (nausea with vomiting), K30 (functional dyspepsia), E11.43 (Type 2 diabetes with diabetic autonomic neuropathy), and R10.13 (epigastric pain). Documentation must clearly link symptoms to the need for gastric emptying assessment.

How long does a gastric emptying study take for billing CPT 78265?

A complete gastric emptying study for CPT 78265 requires imaging at multiple time points over 4 hours (typically at 0, 1, 2, and 4 hours post-meal ingestion). All time points must be documented to support the full code; incomplete studies may be denied or downcoded.