CPT 78725Radiology

Kidney function study

CPT code 78725 is used when a doctor performs a nuclear medicine kidney function study to evaluate how well your kidneys are filtering and processing fluids. This test uses a small amount of radioactive tracer injected into your vein to track kidney function in real-time.

Showing rates for

National Average

Base Medicare rate

$94.45

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

0.38

PE RVU (NF)

2.49

MP RVU

0.05

Total RVU

2.92

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Always verify that radiopharmaceutical administration is included in 78725 and do not separately bill for the tracer injection (A9500-A9699 codes are for the radiopharmaceutical supply only)
Impact: Prevents unbundling denials and potential $50-$150 recoupment for improper separate injection billing
Document whether study includes GFR calculation, as this distinguishes 78725 from other renal imaging codes and supports medical necessity
Impact: Reduces denial rate by approximately 25-30% when quantitative function data is clearly documented
Bill 78725 as global service in private practice settings; use modifier 26 only when hospital owns equipment and employs technologist
Impact: Ensures correct component billing - global pays full $94.45 while 26 modifier typically receives only 30-35% of total fee
Append modifier 59 when performing 78725 with other nuclear medicine procedures on same day only if separate medical necessity is documented
Impact: Prevents automatic NCCI bundling that can reduce reimbursement by 50% or result in complete denial
Link to specific ICD-10 codes for renal dysfunction (N18.x, N17.x, N28.x) rather than non-specific symptoms to establish medical necessity
Impact: Decreases medical necessity denials by 40-45% and reduces prepayment review requests
Ensure separate documentation of kidney function study results in radiology report distinguishing findings from any anatomical imaging performed same day
Impact: Supports billing both functional and anatomical studies when appropriate, potentially adding $100-$300 in additional reimbursement

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 78725?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 78725 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78725 is $94.45 for both facility and non-facility settings. This rate is based on a total RVU of 2.92 multiplied by the 2025 conversion factor of 32.3465. Local Medicare Administrative Contractors (MACs) may have slight geographic variations.

Can CPT 78725 be billed with a CT or ultrasound on the same day?

Yes, CPT 78725 can be billed with CT or ultrasound on the same day as they provide different types of information - 78725 assesses kidney function while CT/ultrasound show anatomy. You may need to append modifier 59 to 78725 to bypass NCCI edits, and documentation must clearly establish separate medical necessity for both the functional and anatomical studies.

What is the difference between CPT 78725 and 78730?

CPT 78725 is a basic kidney function study assessing perfusion and filtration, while CPT 78730 includes additional pharmacological or physiological intervention (such as furosemide washout or captopril challenge). Code 78730 reimburses at a higher rate due to the additional work and time involved in the intervention protocol.

Do I need to bill separately for the radiopharmaceutical used in 78725?

The radiopharmaceutical supply should be billed separately using HCPCS codes A9500-A9699 series (specific code depends on the agent used, such as A9569 for Tc-99m exametazime). However, the injection/administration is included in 78725 and should not be separately coded. Medicare typically reimburses the radiopharmaceutical supply in addition to the procedure code.

How many RVUs is CPT code 78725 worth?

CPT 78725 has a total of 2.92 RVUs for 2025, consisting of 0.38 work RVUs, 2.49 practice expense RVUs, and 0.05 malpractice RVUs. The practice expense RVU is the same (2.49) for both facility and non-facility settings, which is why the reimbursement rate is identical at $94.45.

What diagnosis codes support medical necessity for CPT 78725?

Common ICD-10 codes supporting 78725 medical necessity include N18.x (chronic kidney disease stages), N17.x (acute kidney failure), N28.0 (ischemia and infarction of kidney), N28.9 (disorder of kidney unspecified), I12.x (hypertensive chronic kidney disease), E11.22 (diabetes with CKD), and Z94.0 (kidney transplant status). Documentation should show why functional assessment is needed beyond standard lab tests.

When should I use modifier 26 versus billing CPT 78725 globally?

Use modifier 26 (professional component) only when you are billing solely for the physician's interpretation and a separate entity owns the equipment and employs the technologist (typically in hospital settings). Bill 78725 globally without modifiers when your practice owns the equipment, employs staff, and provides both the technical service and interpretation. The global service receives the full $94.45, while modifier 26 receives only the professional portion (approximately 30-35%).