CPT 78660Radiology

Nuclear exam of tear flow

CPT code 78660 covers a nuclear medicine test that evaluates how well tears drain from your eyes through the tear ducts. A tiny amount of radioactive material is placed in the eye and tracked with a special camera to see if the drainage system is working properly.

Showing rates for

National Average

Base Medicare rate

$127.45

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

0.53

PE RVU (NF)

3.36

MP RVU

0.05

Total RVU

3.94

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

NCCI bundling edits

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Billing tips

Verify whether your payer considers 78660 inherently bilateral or allows modifier 50 for bilateral studies, as policies vary significantly between Medicare contractors and commercial payers
Impact: Could increase reimbursement by 50% ($63.73 additional) if bilateral modifier is accepted, or result in denial/recoupment if incorrectly applied
Always bill separately for the radiopharmaceutical using HCPCS code A9512 (Technetium Tc-99m pertechnetate) with appropriate units, as the drug cost is not included in the 78660 reimbursement
Impact: Recovers $30-60 in additional drug costs that would otherwise be a complete loss if not billed separately
Document the medical necessity with specific indication codes such as H04.20 (epiphora), H04.41 (chronic dacryocystitis), or H04.56 (stenosis of lacrimal sac) to support the appropriateness of nuclear imaging over standard irrigation
Impact: Reduces denial rate by approximately 40% when clear clinical indication differentiates from basic probing or irrigation procedures
If performing both professional and technical components in your facility, bill globally without modifiers 26 or TC to receive the full $127.45 payment
Impact: Prevents payment reduction of 30-70% that occurs when unnecessarily splitting components
Capture time-stamped sequential images at standardized intervals (typically immediately, 5, 10, 15, and 30 minutes post-instillation) and retain all imaging in PACS with interpretation timestamps
Impact: Critical for audit defense; missing time-sequenced documentation accounts for 25% of payment recoupments in nuclear medicine audits
When performed in conjunction with ophthalmic evaluation, ensure the ophthalmology E/M service is separately documented and medically necessary beyond ordering the dacryoscintigraphy to append modifier 25

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Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT code 78660?

The 2025 Medicare national average reimbursement for CPT 78660 is $127.45 for both facility and non-facility settings. This rate is based on 3.94 total RVUs multiplied by the 2025 conversion factor of 32.3465. Local rates may vary based on geographic practice cost indices (GPCI) in your specific Medicare locality.

Can CPT 78660 be billed bilaterally with modifier 50?

Payer policies vary significantly on this issue. Some Medicare Administrative Contractors and commercial payers consider 78660 inherently bilateral (since both lacrimal systems are typically evaluated simultaneously) and do not allow modifier 50. Others permit bilateral billing at 150% reimbursement. Always verify your specific payer's policy before appending modifier 50, and use RT or LT modifiers when only one side is evaluated.

What radiopharmaceutical code should be billed with 78660?

CPT 78660 describes only the imaging and interpretation service. You must separately bill HCPCS code A9512 for Technetium Tc-99m pertechnetate, the radiopharmaceutical typically used for dacryoscintigraphy. Report the appropriate number of units based on the millicuries administered. Failure to bill the radiopharmaceutical separately results in unreimbursed drug costs.

What diagnosis codes support medical necessity for 78660?

Common supporting diagnosis codes include H04.20 (unspecified epiphora), H04.201-H04.209 (epiphora due to excess lacrimation), H04.41-H04.43 (chronic dacryocystitis), H04.51-H04.57 (stenosis and insufficiency of lacrimal passages), and H04.11-H04.13 (dacryops). Documentation should explain why nuclear imaging is necessary beyond simpler tests like fluorescein dye disappearance or irrigation.

How do work RVUs for 78660 compare to other nuclear medicine procedures?

CPT 78660 has 0.53 work RVUs, which is relatively low compared to other nuclear medicine studies. For comparison, bone scans (78306) have 1.50 work RVUs and cardiac stress tests (78452) have 1.68 work RVUs. The lower work RVU reflects the less complex interpretation and shorter physician time required for tear flow studies compared to whole-body or cardiac nuclear imaging.

Can 78660 be billed on the same day as dacryocystorhinostomy surgery?

Billing 78660 on the same day as dacryocystorhinostomy (CPT 68720) or other lacrimal surgery typically requires modifier 59 or XU to indicate a distinct diagnostic service. However, many payers consider pre-operative imaging part of surgical planning and bundle it into the surgical fee. The imaging is most defensible when performed days or weeks before surgery as part of initial diagnostic workup, not immediately pre-operatively.

What is the difference between billing with modifier 26 versus modifier TC for 78660?

Modifier 26 indicates you are billing only the professional component (physician interpretation and report), typically when the test is performed at a hospital or facility you don't own. Modifier TC indicates billing only the technical component (equipment, technologist, radiopharmaceutical, supplies), typically by the facility. The sum of 26 and TC components equals the global $127.45 rate. Only use these modifiers when the professional and technical components are split between different billing entities.