CPT code 78227: Hepatobiliary scan, with pharmacologic intervention2026 Medicare rate & RVUs in Puerto Rico
Reports hepatobiliary nuclear imaging with a medication intervention, such as stimulation of gallbladder emptying, when the clinical question requires a drug-assisted study.
In Puerto Rico, Medicare pays $386.56 for 78227 in the office.
Check a contract rate as a % of Medicare · 78227 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How Puerto Rico compares for 78227
Across 109 of 109 payment localities, the office rate for 78227 runs from $331.57 in Arkansas to $538.57 in San Benito County, CA. Puerto Rico pays $386.56. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$386.56
- Los Angeles, CA · California$446.57+$60.01
- Washington, DC area · District of Columbia$447.00+$60.44
- Miami, FL · Florida$403.23+$16.67
- Chicago, IL · Illinois$389.92+$3.36
- Manhattan, NY · New York$443.60+$57.04
- Alaska · Alaska$418.38+$31.82
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $337.36 | — |
| ArkansasArkansas | $331.57 | — |
| ArizonaArizona | $371.37 | — |
| Bakersfield, CACalifornia | $415.31 | — |
| Chico, CACalifornia | $414.95 | — |
| El Centro, CACalifornia | $414.97 | — |
| Fresno, CACalifornia | $414.95 | — |
| Hanford, CACalifornia | $414.95 | — |
| Madera, CACalifornia | $414.95 | — |
| Merced, CACalifornia | $414.95 | — |
| Modesto, CACalifornia | $414.95 | — |
| Napa, CACalifornia | $493.75 | — |
| Oxnard, CACalifornia | $445.67 | — |
| Redding, CACalifornia | $414.95 | — |
| Rest of CaliforniaCalifornia | $414.95 | — |
| Riverside, CACalifornia | $416.25 | — |
| Sacramento, CACalifornia | $438.92 | — |
| Salinas, CACalifornia | $437.38 | — |
| San Diego, CACalifornia | $450.30 | — |
| Marin County, CACalifornia | $526.64 | — |
| San Francisco, CACalifornia | $526.51 | — |
| San Benito County, CACalifornia | $538.57 | — |
| Santa Clara County, CACalifornia | $538.01 | — |
| San Luis Obispo, CACalifornia | $429.98 | — |
| Santa Cruz, CACalifornia | $456.65 | — |
| Santa Maria, CACalifornia | $439.73 | — |
| Santa Rosa, CACalifornia | $461.45 | — |
| Stockton, CACalifornia | $414.95 | — |
| Vallejo, CACalifornia | $493.56 | — |
| Visalia, CACalifornia | $414.95 | — |
| Yuba City, CACalifornia | $414.95 | — |
| ColoradoColorado | $404.61 | — |
| ConnecticutConnecticut | $411.11 | — |
| DelawareDelaware | $378.32 | — |
| Fort Lauderdale, FLFlorida | $390.55 | — |
| Rest of FloridaFlorida | $369.42 | — |
| Atlanta, GAGeorgia | $389.26 | — |
| Rest of GeorgiaGeorgia | $345.81 | — |
| Hawaii, Guam, HIHawaii | $428.95 | — |
| IowaIowa | $350.66 | — |
| IdahoIdaho | $352.71 | — |
| East St. Louis, ILIllinois | $358.89 | — |
| Rest of IllinoisIllinois | $354.64 | — |
| Suburban Chicago, ILIllinois | $395.51 | — |
| IndianaIndiana | $355.21 | — |
| KansasKansas | $347.25 | — |
| KentuckyKentucky | $343.65 | — |
| New Orleans, LALouisiana | $362.71 | — |
| Rest of LouisianaLouisiana | $342.43 | — |
| Metropolitan Boston, MAMassachusetts | $451.32 | — |
| Rest of MassachusettsMassachusetts | $400.95 | — |
| Baltimore area, MDMaryland | $409.70 | — |
| Rest of MarylandMaryland | $386.93 | — |
| Rest of MaineMaine | $353.31 | — |
| Southern Maine, MEMaine | $378.15 | — |
| Detroit, MIMichigan | $373.30 | — |
| Rest of MichiganMichigan | $352.90 | — |
| MinnesotaMinnesota | $390.08 | — |
| Metropolitan Kansas City, MOMissouri | $361.37 | — |
| Metropolitan St. Louis, MOMissouri | $366.01 | — |
| Rest of MissouriMissouri | $334.46 | — |
| MississippiMississippi | $333.17 | — |
| MontanaMontana | $382.77 | — |
| North CarolinaNorth Carolina | $357.92 | — |
| North DakotaNorth Dakota | $380.39 | — |
| NebraskaNebraska | $353.38 | — |
| New HampshireNew Hampshire | $396.60 | — |
| Northern New JerseyNew Jersey | $440.80 | — |
| Rest of New JerseyNew Jersey | $416.48 | — |
| New MexicoNew Mexico | $354.58 | — |
| NevadaNevada | $382.45 | — |
| NYC suburbs and Long Island, NYNew York | $454.12 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $418.13 | — |
| Queens, NYNew York | $450.01 | — |
| Rest of New YorkNew York | $364.12 | — |
| OhioOhio | $352.41 | — |
| OklahomaOklahoma | $344.50 | — |
| Portland, OROregon | $421.00 | — |
| Rest of OregonOregon | $380.19 | — |
| Metropolitan Philadelphia, PAPennsylvania | $398.40 | — |
| Rest of PennsylvaniaPennsylvania | $353.91 | — |
| Rhode IslandRhode Island | $394.43 | — |
| South CarolinaSouth Carolina | $355.62 | — |
| South DakotaSouth Dakota | $380.11 | — |
| TennesseeTennessee | $349.13 | — |
| Austin, TXTexas | $402.64 | — |
| Beaumont, TXTexas | $351.05 | — |
| Brazoria, TXTexas | $378.98 | — |
| Dallas, TXTexas | $381.07 | — |
| Fort Worth, TXTexas | $377.63 | — |
| Galveston, TXTexas | $379.87 | — |
| Houston, TXTexas | $382.07 | — |
| Rest of TexasTexas | $364.57 | — |
| UtahUtah | $361.40 | — |
| VirginiaVirginia | $375.66 | — |
| Virgin Islands, VIUnited States Virgin Islands | $386.56 | — |
| VermontVermont | $377.30 | — |
| Rest of WashingtonWashington | $400.72 | — |
| King County, WAWashington | $462.82 | — |
| WisconsinWisconsin | $365.33 | — |
| West VirginiaWest Virginia | $338.73 | — |
| WyomingWyoming | $381.73 | — |
78227 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$331.57
$476.76
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $418.38 | 1 |
| AL | $337.36 | 1 |
| AR | $331.57 | 1 |
| AZ | $371.37 | 1 |
| CA | $414.95–$538.57 | 29 |
| CO | $404.61 | 1 |
| CT | $411.11 | 1 |
| DC | $447.00 | 1 |
| DE | $378.32 | 1 |
| FL | $369.42–$403.23 | 3 |
| GA | $345.81–$389.26 | 2 |
| GU | $428.95 | 1 |
| HI | $428.95 | 1 |
| IA | $350.66 | 1 |
| ID | $352.71 | 1 |
| IL | $354.64–$395.51 | 4 |
| IN | $355.21 | 1 |
| KS | $347.25 | 1 |
| KY | $343.65 | 1 |
| LA | $342.43–$362.71 | 2 |
| MA | $400.95–$451.32 | 2 |
| MD | $386.93–$447.00 | 3 |
| ME | $353.31–$378.15 | 2 |
| MI | $352.90–$373.30 | 2 |
| MN | $390.08 | 1 |
| MO | $334.46–$366.01 | 3 |
| MS | $333.17 | 1 |
| MT | $382.77 | 1 |
| NC | $357.92 | 1 |
| ND | $380.39 | 1 |
| NE | $353.38 | 1 |
| NH | $396.60 | 1 |
| NJ | $416.48–$440.80 | 2 |
| NM | $354.58 | 1 |
| NV | $382.45 | 1 |
| NY | $364.12–$454.12 | 5 |
| OH | $352.41 | 1 |
| OK | $344.50 | 1 |
| OR | $380.19–$421.00 | 2 |
| PA | $353.91–$398.40 | 2 |
| PR | $386.56 | 1 |
| RI | $394.43 | 1 |
| SC | $355.62 | 1 |
| SD | $380.11 | 1 |
| TN | $349.13 | 1 |
| TX | $351.05–$402.64 | 8 |
| UT | $361.40 | 1 |
| VA | $375.66–$447.00 | 2 |
| VI | $386.56 | 1 |
| VT | $377.30 | 1 |
| WA | $400.72–$462.82 | 2 |
| WI | $365.33 | 1 |
| WV | $338.73 | 1 |
| WY | $381.73 | 1 |
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.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
9,272
- Code
- 78227
- Physician work
- 0.88
- Practice expense
- 10.46
- Malpractice
- 0.12
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.88 | × 1.000 | 0.8800 |
| Practice expense | 10.46 | × 1.011 | 10.5751 |
| Malpractice | 0.12 | × 0.985 | 0.1182 |
| Total RVUs | 11.5733 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$386.56
Office: (0.88 × 1 + 10.46 × 1.011 + 0.12 × 0.985) × $33.4009 = $386.56
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.
How 78227 has changed in Puerto Rico
78227 · Office / nonfacility
$386.56
Effective 2026-10-01
The base rate is $6.39 higher than on 2025-10-01, moving from $380.17 to $386.56 (1.7%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$380.17changed to$386.56
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.90 changed to 0.88
- Practice expense RVU 10.68 changed to 10.46
- Malpractice RVU 0.10 changed to 0.12
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$399.93changed to$380.17
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 10.93 changed to 10.68
- Malpractice RVU 0.11 changed to 0.10
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$393.41changed to$399.93
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$416.06changed to$393.41
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 11.18 changed to 10.93
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$413.08changed to$416.06
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$431.87changed to$413.08
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 11.38 changed to 11.18
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$455.51changed to$431.87
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 11.97 changed to 11.38
- Malpractice RVU 0.09 changed to 0.11
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$460.57changed to$455.51
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 11.66 changed to 11.97
- Malpractice RVU 0.11 changed to 0.09
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$466.78changed to$460.57
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 11.87 changed to 11.66
- Malpractice RVU 0.10 changed to 0.11
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$476.78changed to$466.78
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 12.16 changed to 11.87
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$407.25changed to$476.78
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 12.13 changed to 12.16
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$407.25
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $386.56 | Not available in this setting | RVU26D |
| 2026-07-01 | $386.56 | Not available in this setting | RVU26C |
| 2026-04-01 | $386.56 | Not available in this setting | RVU26B |
| 2026-01-01 | $386.56 | Not available in this setting | RVU26A |
| 2025-10-01 | $380.17 | Not available in this setting | RVU25D |
| 2025-07-01 | $380.17 | Not available in this setting | RVU25C |
| 2025-04-01 | $380.17 | Not available in this setting | RVU25B |
| 2025-01-01 | $380.17 | Not available in this setting | RVU25A |
| 2024-10-01 | $399.93 | Not available in this setting | RVU24D |
| 2024-07-01 | $399.93 | Not available in this setting | RVU24C |
| 2024-04-01 | $399.93 | Not available in this setting | RVU24B |
| 2024-03-09 | $399.93 | Not available in this setting | RVU24AR |
| 2024-01-01 | $393.41 | Not available in this setting | RVU24A |
| 2023-10-01 | $416.06 | Not available in this setting | RVU23D |
| 2023-07-01 | $413.08 | Not available in this setting | RVU23C |
| 2023-04-01 | $413.08 | Not available in this setting | RVU23B |
| 2023-01-01 | $413.08 | Not available in this setting | RVU23A |
| 2022-10-01 | $431.87 | Not available in this setting | RVU22D |
| 2022-07-01 | $431.87 | Not available in this setting | RVU22C |
| 2022-04-01 | $431.87 | Not available in this setting | RVU22B |
| 2022-01-01 | $431.87 | Not available in this setting | RVU22A |
| 2021-10-01 | $455.51 | Not available in this setting | RVU21D |
| 2021-07-01 | $455.51 | Not available in this setting | RVU21C |
| 2021-04-01 | $455.51 | Not available in this setting | RVU21B |
| 2021-01-01 | $455.51 | Not available in this setting | RVU21A |
| 2020-10-01 | $460.57 | Not available in this setting | RVU20D |
| 2020-07-01 | $460.57 | Not available in this setting | RVU20C |
| 2020-04-01 | $460.57 | Not available in this setting | RVU20B |
| 2020-01-01 | $460.57 | Not available in this setting | RVU20A |
| 2019-10-01 | $466.78 | Not available in this setting | RVU19D |
| 2019-07-01 | $466.78 | Not available in this setting | RVU19C |
| 2019-04-01 | $466.78 | Not available in this setting | RVU19B |
| 2019-01-01 | $466.78 | Not available in this setting | RVU19A |
| 2018-10-01 | $476.78 | Not available in this setting | RVU18D |
| 2018-07-01 | $476.78 | Not available in this setting | RVU18C |
| 2018-04-01 | $476.78 | Not available in this setting | RVU18B |
| 2018-01-01 | $476.78 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $407.25 | Not available in this setting | RVU17D |
| 2017-07-01 | $407.25 | Not available in this setting | RVU17C |
| 2017-04-01 | $407.25 | Not available in this setting | RVU17B |
| 2017-01-01 | $407.25 | Not available in this setting | RVU17A |
| 2016-10-01 | Additional calculation required | Not available in this setting | RVU16D |
| 2016-07-01 | Additional calculation required | Not available in this setting | RVU16C |
| 2016-04-01 | Additional calculation required | Not available in this setting | RVU16B |
| 2016-01-01 | Additional calculation required | Not available in this setting | RVU16A |
| 2015-10-01 | Additional calculation required | Not available in this setting | RVU15D |
| 2015-07-01 | Additional calculation required | Not available in this setting | RVU15C |
| 2015-04-01 | Additional calculation required | Not available in this setting | RVU15B |
| 2015-01-01 | Additional calculation required | Not available in this setting | RVU15A |
| 2014-10-01 | Additional calculation required | Not available in this setting | RVU14D |
| 2014-07-01 | Additional calculation required | Not available in this setting | RVU14C |
| 2014-04-01 | Additional calculation required | Not available in this setting | RVU14B |
| 2014-01-01 | Additional calculation required | Not available in this setting | RVU14A |
| 2013-10-01 | Additional calculation required | Not available in this setting | RVU13D |
| 2013-07-01 | Additional calculation required | Not available in this setting | RVU13C |
| 2013-04-01 | Additional calculation required | Not available in this setting | RVU13B |
| 2013-01-01 | Additional calculation required | Not available in this setting | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
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
Show the CMS file lines behind this rate
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