CPT 78306Radiology

Bone imaging whole body

CPT 78306 covers a whole body bone scan, a nuclear medicine imaging test where a small amount of radioactive tracer is injected to detect bone abnormalities, cancer spread, fractures, or infections throughout the entire skeleton.

Showing rates for

National Average

Base Medicare rate

$256.18

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

0.86

PE RVU (NF)

6.98

MP RVU

0.08

Total RVU

7.92

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

NCCI bundling edits

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Billing tips

Separately report radiopharmaceutical supply using HCPCS code A9503 (Tc-99m MDP) with appropriate units based on dosage administered
Impact: Can add $50-150 to total reimbursement depending on dose; commonly overlooked revenue source
Verify TC/26 split billing arrangements with reading physicians; many facilities incorrectly bill global when split billing is appropriate
Impact: Improper global billing when services are split can result in overpayment recoupment of approximately $23 (professional component value)
Document precise time of radiopharmaceutical injection and imaging start time to demonstrate appropriate 2-4 hour delay required for optimal bone uptake
Impact: Prevents medical necessity denials; auditors specifically look for timing documentation to validate procedure appropriateness
Ensure medical necessity documentation includes specific indication (cancer staging, bone pain evaluation, fracture assessment) linked to appropriate ICD-10 code
Impact: Medical necessity denials account for 30-40% of 78306 claim rejections; strong documentation reduces appeal costs
When billing with same-day CT or MRI studies, append modifier 59 to 78306 if performed for distinct diagnostic purpose with separate documentation
Impact: Prevents bundling denials worth full $256.18; requires clear separation of clinical indications in documentation
For Medicare patients, verify LCD coverage criteria specific to your MAC jurisdiction regarding acceptable indications and frequency limitations
Impact: Regional LCD variations can affect coverage; preemptive verification prevents denials and reduces days in AR by 15-20 days

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78306 in 2025?

The 2025 Medicare national average payment for CPT 78306 is $256.18 for both facility and non-facility settings. This rate is based on 7.92 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality adjustment.

How do you bill for the radiopharmaceutical used in a bone scan?

The radiopharmaceutical (typically Tc-99m MDP) is billed separately using HCPCS code A9503. Report the number of units based on millicuries administered (typically 20-30 mCi for whole body bone scan). This is separate from the CPT 78306 imaging procedure code and adds to total reimbursement.

What is the difference between CPT 78306 and 78315?

CPT 78306 is a whole body bone scan including skull to toes imaging, while 78315 is a limited bone scan imaging three or fewer body areas. Code 78306 has higher reimbursement ($256.18 vs approximately $174) but requires documentation of complete skeletal imaging. The code selection depends on the anatomical extent actually imaged.

Can you bill CPT 78306 with modifier 26 and TC separately?

Yes, CPT 78306 can be split into professional (modifier 26) and technical (modifier TC) components. This is common when the imaging facility owns the equipment and employs technologists (bills TC) while a separate radiologist group provides interpretation (bills 26). Ensure no duplicate global billing occurs.

What diagnosis codes support medical necessity for whole body bone scans?

Common supporting ICD-10 codes include: C79.51 (secondary malignant neoplasm of bone), C61 (prostate cancer), C50.x (breast cancer), M25.50 (unspecified joint pain), M84.3 (stress fracture), and M86.9 (osteomyelitis). The diagnosis must clearly justify whole body imaging rather than limited study.

How often can Medicare patients receive whole body bone scans?

Medicare does not have a universal frequency limitation for CPT 78306, but most MACs consider repeat scans within 3-6 months excessive without documented disease progression or new symptoms. Always document medical necessity for repeat studies including interim clinical changes, treatment completion requiring restaging, or new clinical indication.

What are the work RVUs for CPT 78306?

CPT 78306 has 0.86 work RVUs, 6.98 practice expense RVUs (both facility and non-facility), and 0.08 malpractice RVUs, totaling 7.92 total RVUs for 2025. These values reflect the physician work, practice costs, and liability associated with performing and interpreting whole body bone imaging.