Meckels divert exam
CPT code 78290 covers a nuclear medicine scan to detect Meckel's diverticulum, a congenital abnormality in the small intestine that can cause bleeding or obstruction. The test uses a radioactive tracer to identify ectopic gastric tissue.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Document the exact radiopharmaceutical dose (Tc-99m pertechnetate) and administration time, as Medicare may audit radiopharmaceutical waste and dosing protocols
Impact: Prevents denials and audit recoveries that could result in 100% payment recoupment ($286.27 per claim)
Capture all delayed imaging sequences in documentation; Meckel's scans often require imaging at 15, 30, 45, and 60 minutes post-injection, and incomplete protocols may trigger medical necessity denials
Impact: Ensures full reimbursement and reduces denial rate by approximately 15-20%
Bill 78290 as a global service (without modifiers) when performed in hospital outpatient setting with both technical and professional components, as facility and non-facility rates are identical at $286.27
Impact: Simplifies billing and ensures full payment without modifier-related processing delays
Document pre-medication with H2-blockers or pentagastrin if used to enhance sensitivity, as this supports medical necessity and differentiates from incomplete studies
Impact: Strengthens appeal position for medical necessity reviews and can prevent up to 10% of denials
When billing with modifier 26 for professional component only, ensure the interpreting physician's credentials and NPI are clearly documented on the claim
Impact: Prevents credentialing-related denials that represent 8-12% of initial professional component rejections
Verify age-specific medical necessity documentation for patients over 30 years old, as Meckel's diverticulum is less common in older adults and may trigger additional review
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