CPT 78835Radiology

Rp quan meas single area

CPT code 78835 covers the measurement and calculation of radioactive tracer uptake in a single area of the body during nuclear medicine imaging. This quantitative analysis helps doctors determine how much of the radiopharmaceutical has accumulated in a specific organ or tissue.

Showing rates for

National Average

Base Medicare rate

$85.72

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

0.47

PE RVU (NF)

2.15

MP RVU

0.03

Total RVU

2.65

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

NCCI bundling edits

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Billing tips

Document the specific anatomic area quantified and the clinical reason for quantitation in the interpretation report
Impact: Reduces denial risk by 60-70% through clear medical necessity documentation
Bill 78835 per anatomic area quantified, not per measurement; multiple measurements within the same area count as one unit
Impact: Prevents overbilling audits and recoupment actions that can exceed $500 per incident
Ensure quantitation calculations (ROI values, uptake percentages, SUV) are explicitly recorded in the final report
Impact: Critical for audit defense; missing numerical values result in 80%+ denial rate on review
Verify the base imaging procedure code does not already include quantitation before billing 78835 separately
Impact: Prevents unbundling denials and potential false claims liability; some imaging codes bundle quantitation
When billing with modifier 26 or TC, confirm split billing arrangement with facility to avoid duplicate billing
Impact: Eliminates coordination errors that trigger $85.72 recoupment plus potential compliance penalties
For thyroid uptake studies, confirm whether the primary procedure code already includes the quantitation component
Impact: Thyroid uptake codes often bundle measurement; separate billing may trigger 100% denial

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 78835 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78835 is $85.72 for both facility and non-facility settings. This is based on 2.65 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Can CPT 78835 be billed multiple times on the same date of service?

Yes, 78835 can be billed multiple times when quantitation is performed on distinct, separate anatomic areas during the same session. Use modifier 59 or XS to indicate separate areas. However, multiple measurements within the same anatomic area count as one unit regardless of measurement frequency.

What is the difference between CPT 78835 and the base nuclear medicine imaging code?

CPT 78835 represents the additional quantitative analysis work (calculating uptake percentages, ROI measurements, SUV values) beyond the basic imaging and visual interpretation included in primary nuclear medicine codes. It is billed separately only when formal quantitation is performed and documented.

Do I need modifier 26 or TC when billing CPT 78835?

Use modifier 26 for professional component only (physician interpretation of quantitative measurements) or TC for technical component only (equipment and staff performing measurements). Bill without modifiers only when providing both components in a non-facility setting.

What documentation is required to support billing CPT 78835?

Documentation must include the specific anatomic area quantified, the quantitation method used, actual numerical values or percentages obtained, clinical indication for quantitation, and interpretation of the quantitative findings. Generic statements without numerical data are insufficient.

Is CPT 78835 bundled with thyroid uptake measurement codes?

Many thyroid uptake and scan codes inherently include quantitative measurements as part of the procedure. Check NCCI edits and payer policies carefully before billing 78835 separately with thyroid codes to avoid bundling denials. Documentation must demonstrate additional, distinct quantitative work.

What are the work RVUs for CPT code 78835?

CPT 78835 has 0.47 work RVUs, 2.15 practice expense RVUs, and 0.03 malpractice RVUs, totaling 2.65 RVUs. These values are from the CMS 2025 Medicare Physician Fee Schedule released December 23, 2024.