CPT code 78227: Hepatobiliary scan, with pharmacologic intervention2026 Medicare rate & RVUs in California
Reports hepatobiliary nuclear imaging with a medication intervention, such as stimulation of gallbladder emptying, when the clinical question requires a drug-assisted study.
Medicare pays $414.95–$538.57 for 78227 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
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 78227 covers
A nuclear medicine team administers a hepatobiliary radiotracer and obtains images of tracer movement through the liver and biliary system, including the gallbladder when present. A medication may be used to stimulate gallbladder contraction for an emptying assessment or to alter biliary transit. Studies may help evaluate suspected gallbladder dysfunction or selected biliary disorders. A nuclear medicine physician interprets the images; technologists typically perform the acquisition in a hospital or imaging center.
Choose this code when the study includes pharmacologic intervention, rather than imaging without that intervention. The report should identify the medication and its purpose, describe the imaging and any quantitative measurements, and document the clinical question and interpretation. CMS recognizes a professional component for interpretation and a technical component for equipment and staff: report modifier 26 for the professional service, modifier TC for the technical service, or neither modifier when billing the global service. The study’s medication intervention is part of the described imaging service; radiopharmaceutical supply may be represented by a separate applicable code.
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 78227 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$414.95 to $538.57
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $415.31 | Unavailable |
| Chico, CA | $414.95 | Unavailable |
| El Centro, CA | $414.97 | Unavailable |
| Fresno, CA | $414.95 | Unavailable |
| Hanford, CA | $414.95 | Unavailable |
| Los Angeles, CA | $446.57 | Unavailable |
| Madera, CA | $414.95 | Unavailable |
| Marin County, CA | $526.64 | Unavailable |
| Merced, CA | $414.95 | Unavailable |
| Modesto, CA | $414.95 | Unavailable |
| Napa, CA | $493.75 | Unavailable |
| Oxnard, CA | $445.67 | Unavailable |
| Redding, CA | $414.95 | Unavailable |
| Rest of California | $414.95 | Unavailable |
| Riverside, CA | $416.25 | Unavailable |
| Sacramento, CA | $438.92 | Unavailable |
| Salinas, CA | $437.38 | Unavailable |
| San Benito County, CA | $538.57 | Unavailable |
| San Diego, CA | $450.30 | Unavailable |
| San Francisco, CA | $526.51 | Unavailable |
| San Luis Obispo, CA | $429.98 | Unavailable |
| Santa Clara County, CA | $538.01 | Unavailable |
| Santa Cruz, CA | $456.65 | Unavailable |
| Santa Maria, CA | $439.73 | Unavailable |
| Santa Rosa, CA | $461.45 | Unavailable |
| Stockton, CA | $414.95 | Unavailable |
| Vallejo, CA | $493.56 | Unavailable |
| Visalia, CA | $414.95 | Unavailable |
| Yuba City, CA | $414.95 | Unavailable |
How the 78227 rate is calculated
Each of 78227’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 · 78227
RVUs × geographic indexes × conversion factor
Work0.88
0.88 RVUs× 1.000 GPCI
Practice expense10.46
10.46 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
11.4600
Conversion factor
$33.4009
Medicare rate
$382.77
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 78227
The CMS indicators that decide how 78227 is paid alongside other services.
CMS payment indicators · 78227
Hepatobiliary scan, with pharmacologic intervention
| 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
78227 without 26 · national office
$382.77
Hepatobiliary scan, with pharmacologic intervention
78227-26 · Professional component
$41.08
Pays only the interpretation and report.
78227 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 78226Hepatobiliary imagingWithout drug intervention
- Both cover hepatobiliary imaging; 78227 includes a pharmacologic intervention, while 78226 describes imaging without one.
- 78201Liver imagingStatic images only
- 78201 is static liver imaging. Choose 78227 for a drug-assisted study focused on hepatobiliary tracer transit or gallbladder function.
- 78215Liver-spleen scanStatic images only
- 78215 images the liver and spleen. It is not the drug-assisted hepatobiliary study represented by 78227.
78227 billing questions
How does this differ from 78226?
Use 78227 when the hepatobiliary imaging includes a pharmacologic intervention. Use 78226 for hepatobiliary imaging without that intervention.
Can the interpretation and imaging be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service. Without either modifier, the claim represents the global service.
What should the report document?
Document the medication used and why, the imaging performed, any quantitative measurements, and the physician’s findings and interpretation.
Is this reported once per image or view?
Report the imaging study, not each image or view. The medication-assisted assessment and any quantitative measurements belong to the study.
Can the radiopharmaceutical supply be reported separately?
A hepatobiliary radiopharmaceutical supply code may be relevant, such as A9537 or A9512. The applicable supply billing depends on the setting and the claim circumstances.
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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