CPT 79200Radiology

Nuclear rx intracav admin

CPT 79200 covers the administration of radioactive materials directly into a body cavity (such as the bladder or peritoneal space) for therapeutic purposes. This is a nuclear medicine treatment procedure, not a diagnostic imaging scan.

Showing rates for

National Average

Base Medicare rate

$126.80

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

1.99

PE RVU (NF)

1.88

MP RVU

0.05

Total RVU

3.92

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

NCCI bundling edits

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Billing tips

Bill the radiopharmaceutical supply separately using appropriate HCPCS A-code (e.g., A9606 for chromic phosphate P-32)
Impact: Radiopharmaceutical costs often exceed $1,000-$5,000; failure to bill separately results in significant loss
Document the specific cavity (pleural, peritoneal, pericardial, or bladder) and anatomic approach in operative note
Impact: Prevents 15-20% denial rate for insufficient documentation of medical necessity and site specificity
When imaging guidance is used (fluoroscopy or ultrasound), bill appropriate imaging code separately (e.g., 76000, 77002)
Impact: Adds $50-150 in reimbursement; ensure documentation supports separate identifiable imaging service
Verify patient has not exceeded annual radiation dose limits and document dosimetry calculations in medical record
Impact: Prevents retrospective denials and liability issues; required for compliance with NRC and state regulations
For Medicare patients, ensure radiation oncology or nuclear medicine physician attestation is present within 14 days
Impact: Missing attestation can trigger 100% claim denial or recoupment during audits
Bill on same claim as diagnostic workup codes when performed on different dates to establish medical necessity linkage
Impact: Reduces payer requests for additional documentation by 30-40% when treatment continuum is clear

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 79200 in 2025?

The 2025 Medicare national average reimbursement for CPT 79200 is $126.80 for both facility and non-facility settings. This rate is based on 3.92 total RVUs multiplied by the 2025 conversion factor of 32.3465.

What does CPT code 79200 cover in nuclear medicine?

CPT 79200 covers the intracavitary administration of therapeutic radiopharmaceuticals directly into body cavities such as the pleural space, peritoneal cavity, pericardial space, or bladder. It includes only the administration service; radiopharmaceutical supply and imaging guidance are billed separately.

Can I bill 79200 and an E/M code on the same day?

Yes, you can bill an E/M service on the same day as 79200 if it is a separately identifiable evaluation beyond the administration procedure. Append modifier 25 to the E/M code and document the distinct nature of the evaluation to prevent bundling denials.

What radiopharmaceuticals are typically used with CPT 79200?

Common radiopharmaceuticals for intracavitary administration include chromic phosphate P-32 (HCPCS A9564), sodium phosphate P-32 (A9563), and samarium SM-153 lexidronam (A9604). These are billed separately from the 79200 administration code using appropriate HCPCS codes.

How many RVUs is CPT code 79200 worth?

CPT 79200 has 3.92 total RVUs for 2025, consisting of 1.99 work RVUs, 1.88 practice expense RVUs (both facility and non-facility), and 0.05 malpractice RVUs.

Who can perform intracavitary radiopharmaceutical administration?

Intracavitary radiopharmaceutical administration must be performed by or under the direct supervision of a physician with nuclear medicine or radiation oncology privileges. Technologists must hold ARRT(N) or CNMT certification and appropriate state licensure for handling radioactive materials.

What diagnosis codes support medical necessity for CPT 79200?

Diagnosis codes that support medical necessity for 79200 include malignant pleural effusion (C78.6), malignant peritoneal effusion (C78.6), malignant pericardial effusion (I31.3 with cancer code), and bladder malignancies (C67.x). Documentation must show cavity-specific disease requiring localized radiation therapy.