CPT code 78199: Unlisted procedure, hematopoietic/lymphatic system2026 Medicare rate & RVUs in Maine
Reports an unlisted diagnostic procedure involving the hematopoietic, reticuloendothelial, or lymphatic system when no more specific listed code describes the service.
CMS doesn’t publish an office rate for 78199 in Maine.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest of Maine | Unavailable | Unavailable |
| Southern Maine, ME | Unavailable | Unavailable |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic 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.
78199 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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