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CPT code 78199: Unlisted procedure, hematopoietic/lymphatic system2026 Medicare rate & RVUs

Reports an unlisted diagnostic procedure involving the hematopoietic, reticuloendothelial, or lymphatic system when no more specific listed code describes the service.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 78199

Unlisted procedure, hematopoietic/lymphatic system

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 78199 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 78199 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 78199 covers

78199 identifies an unlisted diagnostic procedure involving the hematopoietic, reticuloendothelial, or lymphatic system. It is selected when no more specific listed procedure code describes the service. Nearby listed nuclear medicine services identify particular studies, including lymphatic imaging, spleen imaging, platelet survival, red-cell survival, and red-cell sequestration; use those codes when their defined study is performed.

For Medicare, 78199 has physician fee schedule status C (carrier priced): CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. The diagnostic test has professional and technical components. Modifier 26 identifies professional interpretation; modifier TC identifies the technical service involving equipment and staff. Reporting 78199 without either modifier represents the global service.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 78199 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

78199 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

78199 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
78199 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 78199 rate is calculated

Each of 78199’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 78199

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 78199

The CMS indicators that decide how 78199 is paid alongside other services.

CMS payment indicators · 78199

Unlisted procedure, hematopoietic/lymphatic system

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical1Diagnostic test with separate professional (26) and technical (TC) components.

What modifiers do to the payment

Modifier 26 · payment effect

With and without the modifier

78199 without 26 · national facility

$0.00

Unlisted procedure, hematopoietic/lymphatic system

78199-26 · Professional component

$0.00

Pays only the interpretation and report.

When to use modifier 26

78199 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 78199

    Unlisted procedure, hematopoietic/lymphatic system0 wRVU

    Not priced

  • 78195

    Lymphatic imaging, lymphoscintigraphy1.17 wRVU

    $311.63

  • 78185

    Spleen imaging, radionuclide study0.39 wRVU

    $154.31

  • 78191

    Platelet study, platelet survival0.59 wRVU

    $126.92

How to choose

78195Lymphatic imagingLymphoscintigraphy
78195 identifies lymphatic system imaging. Use 78199 only when the procedure performed is not described by that listed imaging code or another specific code.
78185Spleen imagingRadionuclide study
78185 identifies a listed spleen imaging study. Use 78199 for a different unlisted procedure involving the relevant system when no specific code describes it.
78191Platelet studyPlatelet survival
78191 identifies a platelet survival study. Use 78199 when the procedure is not that study and no other listed code describes it.

Codes related to 78199

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 78199
CodeHow it relatesNational office range
Used instead
78195Lymphatic imaging, lymphoscintigraphyListed lymphatic imaging code; use it when that is the procedure performed.$271.94–$433.07
78185Spleen imaging, radionuclide studyListed spleen imaging code; use it when that is the procedure performed.$133.82–$216.68
78191Platelet study, platelet survivalListed platelet survival study; use it when that is the procedure performed.$111.00–$174.36
78130Red-cell survival, erythrocyte lifespanListed red-cell survival study; use it when that is the procedure performed.$111.00–$174.36
78140Red-cell study, splenic sequestrationListed red-cell sequestration study; use it when that is the procedure performed.$96.60–$150.40

78199 billing questions

When should 78199 be used instead of a listed code?

Use 78199 when no more specific listed procedure code describes the service performed. For lymphatic system imaging, use 78195 when that listed study describes the service.

How does 78199 differ from spleen imaging code 78185?

78185 identifies a listed spleen imaging study. Use 78199 for a different procedure involving the relevant system only when no specific listed code describes it.

How do modifiers 26 and TC apply?

Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service involving equipment and staff. Reporting 78199 without either modifier represents the global service.

How does Medicare price 78199?

Its physician fee schedule status is C, or carrier priced. CMS publishes no national payment; the Medicare Administrative Contractor sets payment for each claim.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates

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