CPT 78740Radiology

Ureteral reflux study

CPT code 78740 represents a nuclear medicine imaging study that checks whether urine flows backward from the bladder into the ureters and kidneys, a condition called vesicoureteral reflux commonly seen in children with urinary tract infections.

Showing rates for

National Average

Base Medicare rate

$202.81

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

0.57

PE RVU (NF)

5.64

MP RVU

0.06

Total RVU

6.27

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify radiopharmaceutical (Tc-99m DTPA or sulfur colloid) administration is documented with dose, route, and time to support medical necessity
Impact: Missing radiopharmaceutical documentation results in 100% denial rate; proper documentation ensures full $202.81 reimbursement
Document both filling and voiding phases with number of images captured, as incomplete studies may only qualify for modifier 52 reduced payment
Impact: Incomplete study documentation can reduce reimbursement by 50% ($101.41) or result in complete denial
Bill global code without modifiers when practice owns equipment and physician interprets; split with 26/TC when services are divided
Impact: Incorrect modifier usage can delay payment by 30-45 days and may require resubmission with corrected claim
Separately report catheterization code (51701 or 51702) when performed as distinct service prior to reflux study
Impact: Adds $25-45 in additional reimbursement when appropriately documented as separate procedure
Ensure interpretation report specifies reflux grading (I-V), laterality, and clinical correlation with patient's UTI history
Impact: Detailed grading documentation reduces audit risk and supports medical necessity for repeat studies, protecting $202.81 payment
Verify prior authorization requirements for commercial payers, as many require pre-certification for nuclear medicine studies in pediatric patients
Impact: Lack of prior authorization results in denial rates exceeding 60% for commercial payers despite Medicare acceptance

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 78740?

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 78740 in 2025?

The 2025 Medicare national average reimbursement for CPT 78740 is $202.81 for both facility and non-facility settings, based on 6.27 total RVUs and the conversion factor of 32.3465.

Can CPT 78740 be billed with a voiding cystourethrogram on the same day?

Generally no, as both procedures evaluate vesicoureteral reflux and are considered duplicative. If both are medically necessary for different clinical indications, append modifier 59 to 78740 and provide detailed documentation explaining why both studies were required.

What radiopharmaceuticals are appropriate for CPT 78740?

Technetium-99m DTPA or Technetium-99m sulfur colloid are the standard radiopharmaceuticals for direct radionuclide cystography (CPT 78740). The radiopharmaceutical is instilled directly into the bladder via catheter, not injected intravenously.

Do I need to bill catheterization separately with CPT 78740?

Yes, bladder catheterization (CPT 51701 or 51702) can be reported separately as it is not bundled into 78740. Documentation must show catheterization as a distinct procedural service performed prior to radiopharmaceutical instillation.

How do I split bill CPT 78740 between professional and technical components?

Use modifier 26 for professional component (physician interpretation only) and modifier TC for technical component (equipment, staff, radiopharmaceutical). The facility bills TC while the interpreting physician bills 26 when services are performed in separate locations.

What documentation is required to support medical necessity for CPT 78740?

Documentation must include history of recurrent urinary tract infections (typically 2 or more documented episodes), prior imaging results if available, age-appropriate indications, and clinical rationale for choosing nuclear medicine study over fluoroscopic cystography (such as lower radiation exposure in young children).

What are the work RVUs for CPT code 78740?

CPT 78740 has 0.57 work RVUs, 5.64 practice expense RVUs (both facility and non-facility), and 0.06 malpractice RVUs, totaling 6.27 RVUs for 2025.