CPT 78801Radiology

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CPT 78801 covers nuclear medicine imaging used to locate tumors in multiple body areas (2 or more regions) with imaging performed over one or more days. This diagnostic test uses radioactive tracers to identify cancer cells or tumor tissue in different parts of the body.

Showing rates for

National Average

Base Medicare rate

$236.78

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

0.73

PE RVU (NF)

6.52

MP RVU

0.07

Total RVU

7.32

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

NCCI bundling edits

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Billing tips

Document specific anatomical areas imaged (minimum 2 required) and imaging timepoints in radiology report to support 78801 versus 78800
Impact: Prevents downcoding to 78800 ($192.17) - a difference of $44.61 per claim
Verify the radiopharmaceutical used is tumor-specific (octreotide, MIBG, radioiodine, etc.) and document medical necessity for multi-area assessment
Impact: Reduces denial rate by 30-40% when LCD/NCD criteria clearly documented in ordering and interpretation
Bill professional (26) and technical (TC) components separately when services split between entities to maximize compliant reimbursement
Impact: Ensures both facility and physician receive appropriate payment shares totaling full $236.78 allowed amount
Report imaging timeframe in hours/days post-injection in report to justify single versus multiple day protocol selection
Impact: Supports medical necessity documentation and reduces payer audits requesting protocol justification
Verify patient diagnosis codes support tumor imaging indication before scheduling; require active cancer diagnosis or high suspicion codes
Impact: Prevents medical necessity denials which account for 25% of 78801 rejections; pre-authorization approval rates increase 60%
When billing with PET/CT same day, use modifier 59 on 78801 and document different clinical questions addressed by each modality
Impact: Prevents bundling denials and preserves $236.78 reimbursement when both studies medically necessary

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78801 in 2025?

The 2025 Medicare national average reimbursement for CPT 78801 is $236.78 for both facility and non-facility settings. This is based on a total RVU of 7.32 and the 2025 conversion factor of 32.3465.

How many anatomical areas must be imaged to bill CPT 78801?

CPT 78801 requires imaging of 2 or more anatomical areas with one or more days of imaging. If only a single anatomical area is imaged, CPT 78800 should be billed instead. The specific areas must be documented in the radiology report.

What is the difference between CPT 78800 and 78801?

CPT 78800 covers tumor localization in a single area with limited imaging, while CPT 78801 covers 2 or more areas with imaging performed over one or more days. The 78801 code reflects more extensive imaging scope and typically higher resource utilization.

Can CPT 78801 be billed with a PET scan on the same day?

Yes, CPT 78801 can be billed with PET scans when both studies are medically necessary and address different clinical questions. Use modifier 59 on 78801 and document distinct indications, such as different radiopharmaceuticals for different tumor types or confirmation of PET findings with tumor-specific tracer.

What radiopharmaceuticals are typically used for CPT 78801?

Common radiopharmaceuticals include Indium-111 or Gallium-68 octreotide for neuroendocrine tumors, I-131 for thyroid cancer, I-123 or I-131 MIBG for neuroblastoma and pheochromocytoma, and various monoclonal antibodies. The specific agent should be documented in the procedure report.

Does CPT 78801 require prior authorization from Medicare?

Prior authorization requirements vary by Medicare Administrative Contractor (MAC) and patient diagnosis. Many MACs require prior authorization for tumor imaging in certain clinical scenarios. Commercial payers frequently require authorization for all nuclear medicine tumor imaging including 78801.

What are the work RVUs for CPT code 78801 in 2025?

CPT 78801 has a work RVU of 0.73, practice expense RVU of 6.52 (both facility and non-facility), and malpractice RVU of 0.07, totaling 7.32 RVUs. The high practice expense RVU reflects the significant equipment and radiopharmaceutical costs.