CPT 78804Radiology

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CPT 78804 covers whole body nuclear medicine imaging to locate tumors in two or more areas of the body using radioactive tracers. This specialized scan helps doctors identify cancer spread or tumor locations throughout multiple body regions.

Showing rates for

National Average

Base Medicare rate

$552.80

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

1.01

PE RVU (NF)

15.96

MP RVU

0.12

Total RVU

17.09

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

NCCI bundling edits

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Billing tips

Document all anatomical areas imaged (minimum 2 required for 78804) in the radiology report with specific tumor localization findings
Impact: Prevents downcoding to single-area codes (78803) which reimburse approximately $150-200 less; ensures full $552.80 reimbursement
Verify radiotracer type and dose administration are documented separately with appropriate diagnostic radiopharmaceutical code (A9500-A9699 series)
Impact: Radiopharmaceutical drugs billed separately can add $800-3000 depending on agent used (e.g., Octreoscan, FDG); failure to bill separately loses significant revenue
Distinguish 78804 from PET scans (78811-78816) in documentation; do not use for FDG-PET whole body imaging
Impact: Using incorrect code family can result in payment differences of $500-1500; PET codes have different coverage criteria and higher reimbursement
Confirm medical necessity documentation includes specific tumor type, staging indication, or treatment response assessment
Impact: LCD and NCD policies require specific indications; missing documentation leads to 15-25% denial rate for this code
Bill on same date as radiotracer injection only; do not split imaging date from injection date for reimbursement purposes
Impact: Date discrepancies trigger automatic denials; ensure both injection and imaging components share same service date even if delayed imaging protocol used
For split billing arrangements, coordinate 26/TC modifier usage with referring facility to prevent duplicate billing
Impact: Duplicate submissions without proper modifiers result in 100% denial of second claim and potential fraud investigation; coordination ensures both parties receive appropriate portion

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78804 in 2025?

The 2025 Medicare national average reimbursement for CPT 78804 is $552.80 for both facility and non-facility settings. This is based on 17.09 total RVUs (1.01 work RVU, 15.96 PE RVU, 0.12 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

What is the difference between CPT 78804 and 78803?

CPT 78803 covers radiopharmaceutical tumor localization of a single area, while 78804 covers whole body imaging with two or more areas. The key distinction is the number of anatomical regions scanned. Documentation must clearly show imaging of multiple distinct body regions to justify 78804, which has higher reimbursement than the single-area code.

Can CPT 78804 be billed with PET scan codes on the same day?

Yes, but requires careful documentation and appropriate modifiers (typically 59 or XU). The procedures must serve distinct clinical purposes and use different radiopharmaceuticals or imaging technologies. CPT 78804 is for conventional nuclear medicine gamma camera imaging, while PET codes (78811-78816) use positron emission tomography. Clear documentation of separate medical necessity is essential to avoid bundling denials.

What radiopharmaceuticals are typically used for CPT 78804?

Common radiopharmaceuticals include Indium-111 pentetreotide (Octreoscan) for neuroendocrine tumors, Iodine-131 for thyroid cancer, Gallium-67 citrate for lymphoma, and MIBG for neuroblastoma or pheochromocytoma. The specific agent used should be documented and billed separately using the appropriate A-code. Note that FDG (fluorodeoxyglucose) imaging should be coded as PET, not 78804.

How many RVUs is CPT 78804 worth in 2025?

CPT 78804 has 17.09 total RVUs in 2025, consisting of 1.01 work RVUs, 15.96 practice expense RVUs (both facility and non-facility), and 0.12 malpractice RVUs. The high practice expense RVUs reflect the significant equipment and radiopharmaceutical costs associated with nuclear medicine imaging.

What documentation is required to bill CPT 78804 without denials?

Required documentation includes: physician order specifying whole body tumor localization, radiopharmaceutical name and dose with administration details, clear documentation of at least two distinct anatomical areas imaged, clinical indication with specific tumor type and staging purpose, complete nuclear medicine physician interpretation, and image acquisition protocol. Missing any element significantly increases denial risk.

Who can perform and bill for CPT 78804 procedures?

CPT 78804 must be performed under supervision of a board-certified nuclear medicine physician or radiologist with nuclear medicine certification. The facility must hold appropriate radioactive materials licenses. Nuclear medicine technologists performing the technical component must be NMTCB or ARRT(N) certified. Only qualified physicians can bill the professional component (26 modifier), while licensed facilities bill the technical component (TC modifier).