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CPT code 78597: Lung perfusion, differential quantification2026 Medicare rate & RVUs in Puerto Rico

Reports particulate-tracer lung perfusion imaging with quantitative comparison of pulmonary blood flow, often to assess function before planned lung resection.

CMS RVU26DEffective Oct 1, 2026One payment locality1.9K Medicare services in 2024

In Puerto Rico, Medicare pays $181.69 for 78597 in the office.

$181.69Office (non-facility)
Not available in this settingHospital or facility
+0.9%vs the national office rate ($180.03)

Check a contract rate as a % of Medicare · 78597 nationwide

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

We’ll open 78597 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 78597 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 78597 covers

A nuclear medicine technologist administers a particulate radiotracer intravenously and acquires images showing how blood is distributed through the lungs. The study includes quantitative differential analysis, allowing comparison of perfusion between the lungs. A nuclear medicine physician interprets the images. A common clinical use is estimating each lung’s functional contribution before planned lung resection, such as pneumonectomy or lobectomy.

Select this service when the examination includes differential quantitative analysis of pulmonary perfusion, rather than perfusion imaging without that analysis or a combined ventilation-perfusion study. Documentation should identify the clinical question, tracer-based perfusion imaging, and the differential findings or quantitative analysis performed. CMS recognizes a professional component for interpretation and a technical component for equipment and staff: report modifier 26 for the professional portion, modifier TC for the technical portion, or neither modifier when billing 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.

How Puerto Rico compares for 78597

Across 109 of 109 payment localities, the office rate for 78597 runs from $157.40 in Arkansas to $249.69 in San Benito County, CA. Puerto Rico pays $181.69. The RVUs are the same everywhere; the geographic indexes change the dollars.

78597 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$181.69
  2. Los Angeles, CA · California$208.47+$26.78
  3. Washington, DC area · District of Columbia$208.92+$27.23
  4. Miami, FL · Florida$189.39+$7.70
  5. Chicago, IL · Illinois$183.57+$1.88
  6. Manhattan, NY · New York$207.66+$25.97
  7. Alaska · Alaska$201.31+$19.62

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

78597 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$159.96—
ArkansasArkansas$157.40—
ArizonaArizona$174.98—
Bakersfield, CACalifornia$194.46—
Chico, CACalifornia$194.27—
El Centro, CACalifornia$194.28—
Fresno, CACalifornia$194.27—
Hanford, CACalifornia$194.27—

78597 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.

$157.40

$221.98

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
78597 office rate range by state
State / territoryOffice rate rangeLocalities
AK$201.311
AL$159.961
AR$157.401
AZ$174.981
CA$194.27–$249.6929
CO$189.721
CT$192.771
DC$208.921
DE$178.111
FL$174.28–$189.393
GA$163.82–$182.972
GU$200.241
HI$200.241
IA$165.761
ID$166.681
IL$167.79–$185.904
IN$167.781
KS$164.291
KY$162.811
LA$162.28–$171.242
MA$188.16–$210.622
MD$181.95–$208.923
ME$166.98–$177.912
MI$166.92–$176.032
MN$183.081
MO$158.78–$172.663
MS$158.151
MT$180.031
NC$169.011
ND$178.841
NE$166.951
NH$186.081
NJ$195.34–$206.292
NM$167.681
NV$179.851
NY$171.75–$212.355
OH$166.681
OK$163.141
OR$178.82–$196.962
PA$167.32–$187.162
PR$181.691
RI$185.351
SC$168.051
SD$178.701
TN$165.121
TX$166.06–$188.768
UT$170.611
VA$176.83–$208.922
VI$181.691
VT$177.501
WA$188.01–$215.762
WI$172.191
WV$160.771
WY$179.511

See 78597 in every payment locality

How the 78597 rate is calculated

Each of 78597’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 · 78597

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.73

0.73 RVUs× 1.000 GPCI

Practice expense4.60

4.60 RVUs× 1.000 GPCI

Malpractice0.06

0.06 RVUs× 1.000 GPCI

Adjusted RVUs

5.3900

Conversion factor

$33.4009

Medicare rate

$180.03

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

9,434

Code
78597
Physician work
0.73
Practice expense
4.60
Malpractice
0.06

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 78597 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work0.73× 1.0000.7300
Practice expense4.60× 1.0114.6506
Malpractice0.06× 0.9850.0591
Total RVUs5.4397
Conversion factor× 33.4009

Office rate, Puerto Rico$181.69

Office: (0.73 × 1 + 4.6 × 1.011 + 0.06 × 0.985) × $33.4009 = $181.69

Open 78597 in the RVU calculator

Payment rules and modifiers for 78597

The CMS indicators that decide how 78597 is paid alongside other services.

CMS payment indicators · 78597

Lung perfusion, differential quantification

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

78597 without 26 · national office

$180.03

Lung perfusion, differential quantification

78597-26 · Professional component

$33.07

Pays only the interpretation and report.

When to use modifier 26

Codes related to 78597

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

Codes related to 78597
CodeHow it relatesOffice range, Puerto Rico
Used instead
78580Lung perfusion scan, perfusion onlyPerfusion imaging without the differential quantitative analysis included in 78597.$211.39
78598Lung V/Q imaging, differential ventilation and perfusionDifferential quantitative imaging of both lung ventilation and perfusion.$267.40
78582Lung scan, ventilation and perfusionCombined lung ventilation-perfusion imaging without differential quantification.$293.31

How 78597 has changed in Puerto Rico

78597 · Office / nonfacility

$181.69

Effective 2026-10-01

The base rate is $4.71 higher than on 2025-10-01, moving from $176.98 to $181.69 (2.7%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $176.98changed to$181.69

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.75 changed to 0.73
    • Practice expense RVU 4.63 changed to 4.60
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $184.47changed to$176.98

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.70 changed to 4.63

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $181.46changed to$184.47

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $192.04changed to$181.46

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.80 changed to 4.70
    • Malpractice RVU 0.08 changed to 0.06
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $190.78changed to$192.04

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $198.93changed to$190.78

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.90 changed to 4.80
    • Malpractice RVU 0.06 changed to 0.08
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $209.00changed to$198.93

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.12 changed to 4.90
    • Malpractice RVU 0.08 changed to 0.06

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $208.56changed to$209.00

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.94 changed to 5.12
    • Malpractice RVU 0.05 changed to 0.08
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $209.91changed to$208.56

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.99 changed to 4.94
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $215.47changed to$209.91

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.14 changed to 4.99
    • Malpractice RVU 0.06 changed to 0.05

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $184.74changed to$215.47

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.10 changed to 5.14
    • Malpractice RVU 0.05 changed to 0.06
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $155.71changed to$184.74

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.08 changed to 5.10
    • Malpractice RVU 0.06 changed to 0.05
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $155.51changed to$155.71

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.05 changed to 5.08

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $154.74changed to$155.51

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $150.46changed to$154.74

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.97 changed to 5.05
    • Malpractice RVU 0.04 changed to 0.06
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $173.03changed to$150.46

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.38 changed to 4.97
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $173.03

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$181.69Not available in this settingRVU26D
2026-07-01$181.69Not available in this settingRVU26C
2026-04-01$181.69Not available in this settingRVU26B
2026-01-01$181.69Not available in this settingRVU26A
2025-10-01$176.98Not available in this settingRVU25D
2025-07-01$176.98Not available in this settingRVU25C
2025-04-01$176.98Not available in this settingRVU25B
2025-01-01$176.98Not available in this settingRVU25A
2024-10-01$184.47Not available in this settingRVU24D
2024-07-01$184.47Not available in this settingRVU24C
2024-04-01$184.47Not available in this settingRVU24B
2024-03-09$184.47Not available in this settingRVU24AR
2024-01-01$181.46Not available in this settingRVU24A
2023-10-01$192.04Not available in this settingRVU23D
2023-07-01$190.78Not available in this settingRVU23C
2023-04-01$190.78Not available in this settingRVU23B
2023-01-01$190.78Not available in this settingRVU23A
2022-10-01$198.93Not available in this settingRVU22D
2022-07-01$198.93Not available in this settingRVU22C
2022-04-01$198.93Not available in this settingRVU22B
2022-01-01$198.93Not available in this settingRVU22A
2021-10-01$209.00Not available in this settingRVU21D
2021-07-01$209.00Not available in this settingRVU21C
2021-04-01$209.00Not available in this settingRVU21B
2021-01-01$209.00Not available in this settingRVU21A
2020-10-01$208.56Not available in this settingRVU20D
2020-07-01$208.56Not available in this settingRVU20C
2020-04-01$208.56Not available in this settingRVU20B
2020-01-01$208.56Not available in this settingRVU20A
2019-10-01$209.91Not available in this settingRVU19D
2019-07-01$209.91Not available in this settingRVU19C
2019-04-01$209.91Not available in this settingRVU19B
2019-01-01$209.91Not available in this settingRVU19A
2018-10-01$215.47Not available in this settingRVU18D
2018-07-01$215.47Not available in this settingRVU18C
2018-04-01$215.47Not available in this settingRVU18B
2018-01-01$215.47Not available in this settingRVU18AR1
2017-10-01$184.74Not available in this settingRVU17D
2017-07-01$184.74Not available in this settingRVU17C
2017-04-01$184.74Not available in this settingRVU17B
2017-01-01$184.74Not available in this settingRVU17A
2016-10-01$155.71Not available in this settingRVU16D
2016-07-01$155.71Not available in this settingRVU16C
2016-04-01$155.71Not available in this settingRVU16B
2016-01-01$155.71Not available in this settingRVU16A
2015-10-01$155.51Not available in this settingRVU15D
2015-07-01$155.51Not available in this settingRVU15C
2015-04-01$154.74Not available in this settingRVU15B
2015-01-01$154.74Not available in this settingRVU15A
2014-10-01$150.46Not available in this settingRVU14D
2014-07-01$150.46Not available in this settingRVU14C
2014-04-01$150.46Not available in this settingRVU14B
2014-01-01$150.46Not available in this settingRVU14A
2013-10-01$173.03Not available in this settingRVU13D
2013-07-01$173.03Not available in this settingRVU13C
2013-04-01$173.03Not available in this settingRVU13B
2013-01-01$173.03Not available in this settingRVU13AR

Price 78597 for an earlier date of service

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

Browse all communities in Puerto Rico

78597 billing questions

How is 78597 different from 78580?

78597 includes differential quantitative analysis of lung perfusion. Use 78580 for particulate-tracer perfusion imaging without that differential analysis.

When would 78598 be a better fit?

Use 78598 when the study includes differential quantitative evaluation of both lung ventilation and perfusion. 78597 is for differential perfusion imaging.

Can the interpretation and imaging portions be billed separately?

Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical portion. Billing without either modifier represents the global service.

Is quantitative analysis separately reported?

The differential quantitative analysis is part of the service represented by 78597; it is not a separate service within this code.

What documentation supports reporting 78597?

Document the clinical reason for the scan, the particulate-tracer perfusion study, and the differential quantitative assessment of pulmonary perfusion.

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
RVUs for 78597PPRRVU2026_Oct_nonQPP.csv, line 9,434 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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