CPT 78831Radiology

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CPT code 78831 covers a specialized nuclear medicine imaging procedure that uses radioactive tracers and SPECT (Single Photon Emission Computed Tomography) technology to locate tumors or abnormal tissue in two different areas of the body. This advanced 3D imaging helps doctors pinpoint exactly where cancer or other diseases are located.

Showing rates for

National Average

Base Medicare rate

$612.97

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

1.82

PE RVU (NF)

16.98

MP RVU

0.15

Total RVU

18.95

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

NCCI bundling edits

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Billing tips

Always document both anatomic areas imaged with specific location descriptions (e.g., 'thorax and pelvis' not just 'two areas') in the radiology report
Impact: Prevents denials for insufficient documentation; estimated 15-20% denial rate reduction
Verify that SPECT imaging was actually performed and documented - planar-only imaging should be coded with 78830 or other appropriate codes
Impact: SPECT codes reimburse significantly higher; incorrect upcoding can trigger $612.97 overpayment recovery plus penalties
Bill radiopharmaceutical separately using appropriate A9xxx HCPCS codes (e.g., A9562 for Tc-99m Mertiatide) as 78831 covers only the imaging service
Impact: Additional $150-$800 reimbursement depending on radiopharmaceutical used
For Medicare patients, ensure medical necessity documentation includes cancer diagnosis or suspected malignancy with specific ICD-10 codes
Impact: Prevents medical necessity denials which account for approximately 25% of nuclear medicine claim rejections
When performed same day as other imaging, append modifier 59 only if truly distinct and separate from other procedures; document separate clinical indication
Impact: Improper modifier 59 use risks audit flags; proper use protects $612.97 payment from bundling
Verify that pre-authorization was obtained before scheduling as most commercial payers require it for SPECT tumor imaging
Impact: Prevents 100% denial of $612.97 charge; pre-auth denials are difficult to overturn retrospectively

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78831 in 2025?

The 2025 Medicare national average reimbursement for CPT 78831 is $612.97 for both facility and non-facility settings. This rate is based on 18.95 total RVUs (1.82 work RVU + 16.98 PE RVU + 0.15 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 78830 and 78831?

CPT 78830 covers SPECT tumor localization for a single area, while 78831 covers two areas. The distinction is critical for proper billing - 78831 reimburses higher but requires documentation of two distinct, non-contiguous anatomic regions. Using 78831 for single-area imaging constitutes upcoding.

Can CPT 78831 be billed with a PET scan on the same day?

Yes, but it requires careful documentation of medical necessity for both studies. Append modifier 59 to indicate a distinct procedural service and document different clinical indications, different radiopharmaceuticals, or complementary diagnostic information. Many payers will bundle these services without compelling justification.

What modifiers are most commonly used with CPT 78831?

The most common modifiers are 26 (professional component only) and TC (technical component only) for split billing arrangements. Modifier 59 is used when performed with other imaging to prevent bundling. Modifier 52 may be needed if reduced services were provided due to patient factors.

How many RVUs is CPT code 78831 worth in 2025?

CPT 78831 has 18.95 total RVUs in 2025, consisting of 1.82 work RVUs, 16.98 practice expense RVUs, and 0.15 malpractice RVUs. This is a high-value imaging code due to the technical complexity and equipment costs of SPECT imaging.

What diagnosis codes support medical necessity for CPT 78831?

Primary malignancies (C codes), secondary malignancies (metastatic disease codes), and suspected neoplasms typically support medical necessity. Specific covered diagnoses include lung cancer, lymphoma, melanoma, neuroendocrine tumors, and bone metastases. Always verify Local Coverage Determinations (LCDs) for your MAC jurisdiction.

Do I need to bill the radiopharmaceutical separately from CPT 78831?

Yes, CPT 78831 covers only the imaging service and interpretation. The radiopharmaceutical must be billed separately using the appropriate HCPCS A9xxx code (e.g., A9562 for Tc-99m, A9568 for Tc-99m arcitumomab). This represents additional reimbursement beyond the $612.97 imaging fee.