CPT code 78645: CSF shunt study, shunt patency assessment2026 Medicare rate & RVUs in Virgin Islands, VI
Nuclear medicine imaging tracks radiotracer movement through a cerebrospinal fluid shunt to investigate suspected impaired flow or shunt malfunction.
In Virgin Islands, VI, Medicare pays $288.11 for 78645 in the office.
Check a contract rate as a % of Medicare · 78645 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 78645 covers
This study evaluates flow through an implanted cerebrospinal fluid shunt, commonly when symptoms or other findings raise concern for obstruction or malfunction. A nuclear medicine team administers radiotracer through the shunt access point and obtains images to follow its movement through the shunt pathway. The study may help assess whether flow is occurring and where it appears impaired.
Report 78645 for the shunt-focused radionuclide evaluation, rather than a study directed at general CSF circulation, ventricular imaging, or leak localization. Documentation should identify the clinical concern, the shunt evaluated, the radiotracer administration and imaging performed, and the interpretation of tracer progression. CMS recognizes professional and technical components: report modifier 26 for the interpretation, modifier TC for equipment and staff, or no component modifier for the global service. The professional and technical components are separately priced.
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 Virgin Islands, VI compares for 78645
Across 109 of 109 payment localities, the office rate for 78645 runs from $246.74 in Arkansas to $402.69 in San Benito County, CA. Virgin Islands, VI pays $288.11. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Virgin Islands, VI · this page$288.11
- Los Angeles, CA · California$333.40+$45.29
- Washington, DC area · District of Columbia$333.52+$45.41
- Miami, FL · Florida$300.15+$12.04
- Chicago, IL · Illinois$290.15+$2.04
- Manhattan, NY · New York$330.75+$42.64
- Alaska · Alaska$310.55+$22.44
Other areas in United States Virgin Islands first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $251.10 | — |
| ArkansasArkansas | $246.74 | — |
| ArizonaArizona | $276.68 | — |
| Bakersfield, CACalifornia | $309.89 | — |
| Chico, CACalifornia | $309.65 | — |
| El Centro, CACalifornia | $309.67 | — |
| Fresno, CACalifornia | $309.65 | — |
| Hanford, CACalifornia | $309.65 | — |
| Madera, CACalifornia | $309.65 | — |
| Merced, CACalifornia | $309.65 | — |
| Modesto, CACalifornia | $309.65 | — |
| Napa, CACalifornia | $369.02 | — |
| Oxnard, CACalifornia | $332.78 | — |
| Redding, CACalifornia | $309.65 | — |
| Rest of CaliforniaCalifornia | $309.65 | — |
| Riverside, CACalifornia | $310.52 | — |
| Sacramento, CACalifornia | $327.69 | — |
| Salinas, CACalifornia | $326.54 | — |
| San Diego, CACalifornia | $336.30 | — |
| Marin County, CACalifornia | $393.76 | — |
| San Francisco, CACalifornia | $393.67 | — |
| San Benito County, CACalifornia | $402.69 | — |
| Santa Clara County, CACalifornia | $402.32 | — |
| San Luis Obispo, CACalifornia | $321.00 | — |
| Santa Cruz, CACalifornia | $341.13 | — |
| Santa Maria, CACalifornia | $328.33 | — |
| Santa Rosa, CACalifornia | $344.73 | — |
| Stockton, CACalifornia | $309.65 | — |
| Vallejo, CACalifornia | $368.89 | — |
| Visalia, CACalifornia | $309.65 | — |
| Yuba City, CACalifornia | $309.65 | — |
| ColoradoColorado | $301.77 | — |
| ConnecticutConnecticut | $306.50 | — |
| DelawareDelaware | $281.90 | — |
| Fort Lauderdale, FLFlorida | $290.83 | — |
| Rest of FloridaFlorida | $274.98 | — |
| Atlanta, GAGeorgia | $290.06 | — |
| Rest of GeorgiaGeorgia | $257.26 | — |
| Hawaii, Guam, HIHawaii | $320.27 | — |
| IowaIowa | $261.20 | — |
| IdahoIdaho | $262.73 | — |
| East St. Louis, ILIllinois | $266.84 | — |
| Rest of IllinoisIllinois | $263.79 | — |
| Suburban Chicago, ILIllinois | $294.56 | — |
| IndianaIndiana | $264.61 | — |
| KansasKansas | $258.59 | — |
| KentuckyKentucky | $255.73 | — |
| New Orleans, LALouisiana | $270.04 | — |
| Rest of LouisianaLouisiana | $254.79 | — |
| Metropolitan Boston, MAMassachusetts | $336.91 | — |
| Rest of MassachusettsMassachusetts | $298.99 | — |
| Baltimore area, MDMaryland | $305.44 | — |
| Rest of MarylandMaryland | $288.38 | — |
| Rest of MaineMaine | $263.12 | — |
| Southern Maine, MEMaine | $281.88 | — |
| Detroit, MIMichigan | $277.84 | — |
| Rest of MichiganMichigan | $262.63 | — |
| MinnesotaMinnesota | $291.01 | — |
| Metropolitan Kansas City, MOMissouri | $269.09 | — |
| Metropolitan St. Louis, MOMissouri | $272.58 | — |
| Rest of MissouriMissouri | $248.76 | — |
| MississippiMississippi | $247.87 | — |
| MontanaMontana | $285.24 | — |
| North CarolinaNorth Carolina | $266.60 | — |
| North DakotaNorth Dakota | $283.66 | — |
| NebraskaNebraska | $263.26 | — |
| New HampshireNew Hampshire | $295.73 | — |
| Northern New JerseyNew Jersey | $328.82 | — |
| Rest of New JerseyNew Jersey | $310.53 | — |
| New MexicoNew Mexico | $263.88 | — |
| NevadaNevada | $285.06 | — |
| NYC suburbs and Long Island, NYNew York | $338.60 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $311.71 | — |
| Queens, NYNew York | $335.65 | — |
| Rest of New YorkNew York | $271.26 | — |
| OhioOhio | $262.31 | — |
| OklahomaOklahoma | $256.41 | — |
| Portland, OROregon | $314.15 | — |
| Rest of OregonOregon | $283.39 | — |
| Metropolitan Philadelphia, PAPennsylvania | $296.91 | — |
| Rest of PennsylvaniaPennsylvania | $263.46 | — |
| Puerto RicoPuerto Rico | $288.11 | — |
| Rhode IslandRhode Island | $294.02 | — |
| South CarolinaSouth Carolina | $264.79 | — |
| South DakotaSouth Dakota | $283.47 | — |
| TennesseeTennessee | $259.99 | — |
| Austin, TXTexas | $300.28 | — |
| Beaumont, TXTexas | $261.31 | — |
| Brazoria, TXTexas | $282.43 | — |
| Dallas, TXTexas | $283.98 | — |
| Fort Worth, TXTexas | $281.37 | — |
| Galveston, TXTexas | $283.09 | — |
| Houston, TXTexas | $284.55 | — |
| Rest of TexasTexas | $271.53 | — |
| UtahUtah | $269.14 | — |
| VirginiaVirginia | $279.97 | — |
| VermontVermont | $281.29 | — |
| Rest of WashingtonWashington | $298.83 | — |
| King County, WAWashington | $345.59 | — |
| WisconsinWisconsin | $272.31 | — |
| West VirginiaWest Virginia | $251.83 | — |
| WyomingWyoming | $284.55 | — |
78645 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.
$246.74
$356.17
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 | $310.55 | 1 |
| AL | $251.10 | 1 |
| AR | $246.74 | 1 |
| AZ | $276.68 | 1 |
| CA | $309.65–$402.69 | 29 |
| CO | $301.77 | 1 |
| CT | $306.50 | 1 |
| DC | $333.52 | 1 |
| DE | $281.90 | 1 |
| FL | $274.98–$300.15 | 3 |
| GA | $257.26–$290.06 | 2 |
| GU | $320.27 | 1 |
| HI | $320.27 | 1 |
| IA | $261.20 | 1 |
| ID | $262.73 | 1 |
| IL | $263.79–$294.56 | 4 |
| IN | $264.61 | 1 |
| KS | $258.59 | 1 |
| KY | $255.73 | 1 |
| LA | $254.79–$270.04 | 2 |
| MA | $298.99–$336.91 | 2 |
| MD | $288.38–$333.52 | 3 |
| ME | $263.12–$281.88 | 2 |
| MI | $262.63–$277.84 | 2 |
| MN | $291.01 | 1 |
| MO | $248.76–$272.58 | 3 |
| MS | $247.87 | 1 |
| MT | $285.24 | 1 |
| NC | $266.60 | 1 |
| ND | $283.66 | 1 |
| NE | $263.26 | 1 |
| NH | $295.73 | 1 |
| NJ | $310.53–$328.82 | 2 |
| NM | $263.88 | 1 |
| NV | $285.06 | 1 |
| NY | $271.26–$338.60 | 5 |
| OH | $262.31 | 1 |
| OK | $256.41 | 1 |
| OR | $283.39–$314.15 | 2 |
| PA | $263.46–$296.91 | 2 |
| PR | $288.11 | 1 |
| RI | $294.02 | 1 |
| SC | $264.79 | 1 |
| SD | $283.47 | 1 |
| TN | $259.99 | 1 |
| TX | $261.31–$300.28 | 8 |
| UT | $269.14 | 1 |
| VA | $279.97–$333.52 | 2 |
| VI | $288.11 | 1 |
| VT | $281.29 | 1 |
| WA | $298.83–$345.59 | 2 |
| WI | $272.31 | 1 |
| WV | $251.83 | 1 |
| WY | $284.55 | 1 |
How the 78645 rate is calculated
Each of 78645’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 · 78645
RVUs × geographic indexes × conversion factor
Work0.56
0.56 RVUs× 1.000 GPCI
Practice expense7.90
7.90 RVUs× 1.000 GPCI
Malpractice0.08
0.08 RVUs× 1.000 GPCI
Adjusted RVUs
8.5400
Conversion factor
$33.4009
Medicare rate
$285.24
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Virgin Islands, VI inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
9,470
- Code
- 78645
- Physician work
- 0.56
- Practice expense
- 7.90
- Malpractice
- 0.08
GPCI2026.csv
107
- Locality
- Virgin Islands, VI
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.56 | × 1.000 | 0.5600 |
| Practice expense | 7.90 | × 1.011 | 7.9869 |
| Malpractice | 0.08 | × 0.985 | 0.0788 |
| Total RVUs | 8.6257 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Virgin Islands, VI$288.11
Office: (0.56 × 1 + 7.9 × 1.011 + 0.08 × 0.985) × $33.4009 = $288.11
Payment rules and modifiers for 78645
The CMS indicators that decide how 78645 is paid alongside other services.
CMS payment indicators · 78645
CSF shunt study, shunt patency assessment
| 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
78645 without 26 · national office
$285.24
CSF shunt study, shunt patency assessment
78645-26 · Professional component
$25.72
Pays only the interpretation and report.
How 78645 has changed in Virgin Islands, VI
78645 · Office / nonfacility
$288.11
Effective 2026-10-01
The base rate is $4.92 higher than on 2025-10-01, moving from $283.19 to $288.11 (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
$283.19changed to$288.11
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.57 changed to 0.56
- Practice expense RVU 8.05 changed to 7.90
- 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
$296.78changed to$283.19
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 8.20 changed to 8.05
- Malpractice RVU 0.09 changed to 0.08
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$291.94changed to$296.78
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$306.88changed to$291.94
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 8.36 changed to 8.20
- Malpractice RVU 0.06 changed to 0.09
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$304.65changed to$306.88
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$318.62changed to$304.65
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 8.50 changed to 8.36
- Malpractice RVU 0.07 changed to 0.06
- 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
$334.63changed to$318.62
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 8.88 changed to 8.50
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$337.38changed to$334.63
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 8.64 changed to 8.88
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$339.86changed to$337.38
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 8.73 changed to 8.64
- 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
$345.65changed to$339.86
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 8.90 changed to 8.73
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$342.47changed to$345.65
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 8.85 changed to 8.90
- Practice expense GPCI 1.006 changed to 1.007
- Malpractice GPCI 0.993 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$324.35changed to$342.47
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 8.77 changed to 8.85
- Practice expense GPCI 0.960 changed to 1.006
- Malpractice GPCI 0.996 changed to 0.993
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$325.17changed to$324.35
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 8.76 changed to 8.77
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$323.56changed to$325.17
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$331.16changed to$323.56
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 8.58 changed to 8.76
- Malpractice RVU 0.06 changed to 0.07
- Practice expense GPCI 1.004 changed to 0.960
- Malpractice GPCI 1.003 changed to 0.996
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$331.16
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $288.11 | Not available in this setting | RVU26D |
| 2026-07-01 | $288.11 | Not available in this setting | RVU26C |
| 2026-04-01 | $288.11 | Not available in this setting | RVU26B |
| 2026-01-01 | $288.11 | Not available in this setting | RVU26A |
| 2025-10-01 | $283.19 | Not available in this setting | RVU25D |
| 2025-07-01 | $283.19 | Not available in this setting | RVU25C |
| 2025-04-01 | $283.19 | Not available in this setting | RVU25B |
| 2025-01-01 | $283.19 | Not available in this setting | RVU25A |
| 2024-10-01 | $296.78 | Not available in this setting | RVU24D |
| 2024-07-01 | $296.78 | Not available in this setting | RVU24C |
| 2024-04-01 | $296.78 | Not available in this setting | RVU24B |
| 2024-03-09 | $296.78 | Not available in this setting | RVU24AR |
| 2024-01-01 | $291.94 | Not available in this setting | RVU24A |
| 2023-10-01 | $306.88 | Not available in this setting | RVU23D |
| 2023-07-01 | $304.65 | Not available in this setting | RVU23C |
| 2023-04-01 | $304.65 | Not available in this setting | RVU23B |
| 2023-01-01 | $304.65 | Not available in this setting | RVU23A |
| 2022-10-01 | $318.62 | Not available in this setting | RVU22D |
| 2022-07-01 | $318.62 | Not available in this setting | RVU22C |
| 2022-04-01 | $318.62 | Not available in this setting | RVU22B |
| 2022-01-01 | $318.62 | Not available in this setting | RVU22A |
| 2021-10-01 | $334.63 | Not available in this setting | RVU21D |
| 2021-07-01 | $334.63 | Not available in this setting | RVU21C |
| 2021-04-01 | $334.63 | Not available in this setting | RVU21B |
| 2021-01-01 | $334.63 | Not available in this setting | RVU21A |
| 2020-10-01 | $337.38 | Not available in this setting | RVU20D |
| 2020-07-01 | $337.38 | Not available in this setting | RVU20C |
| 2020-04-01 | $337.38 | Not available in this setting | RVU20B |
| 2020-01-01 | $337.38 | Not available in this setting | RVU20A |
| 2019-10-01 | $339.86 | Not available in this setting | RVU19D |
| 2019-07-01 | $339.86 | Not available in this setting | RVU19C |
| 2019-04-01 | $339.86 | Not available in this setting | RVU19B |
| 2019-01-01 | $339.86 | Not available in this setting | RVU19A |
| 2018-10-01 | $345.65 | Not available in this setting | RVU18D |
| 2018-07-01 | $345.65 | Not available in this setting | RVU18C |
| 2018-04-01 | $345.65 | Not available in this setting | RVU18B |
| 2018-01-01 | $345.65 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $342.47 | Not available in this setting | RVU17D |
| 2017-07-01 | $342.47 | Not available in this setting | RVU17C |
| 2017-04-01 | $342.47 | Not available in this setting | RVU17B |
| 2017-01-01 | $342.47 | Not available in this setting | RVU17A |
| 2016-10-01 | $324.35 | Not available in this setting | RVU16D |
| 2016-07-01 | $324.35 | Not available in this setting | RVU16C |
| 2016-04-01 | $324.35 | Not available in this setting | RVU16B |
| 2016-01-01 | $324.35 | Not available in this setting | RVU16A |
| 2015-10-01 | $325.17 | Not available in this setting | RVU15D |
| 2015-07-01 | $325.17 | Not available in this setting | RVU15C |
| 2015-04-01 | $323.56 | Not available in this setting | RVU15B |
| 2015-01-01 | $323.56 | Not available in this setting | RVU15A |
| 2014-10-01 | $331.16 | Not available in this setting | RVU14D |
| 2014-07-01 | $331.16 | Not available in this setting | RVU14C |
| 2014-04-01 | $331.16 | Not available in this setting | RVU14B |
| 2014-01-01 | $331.16 | 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 Virgin Islands, VI rate applies
Virgin Islands, VI is a Medicare payment area, not a city. Our Census mapping connects it to 10 cities and communities in United States Virgin Islands. Some span more than one payment area; confirm with the service ZIP.
- Charlotte Amalie
- Charlotte Amalie East
- Charlotte Amalie West
- Christiansted
- Coral Bay
- Cruz Bay
- Frederiksted
- Frederiksted Southeast
78645 billing questions
When should I report 78645 instead of a CSF cisternography code?
Report 78645 when the imaging evaluates flow through an implanted CSF shunt. Cisternography evaluates CSF circulation rather than shunt patency.
How do I report the professional and technical portions?
Use modifier 26 for the professional interpretation and modifier TC for the technical service. Without either modifier, the claim represents the global service.
What documentation supports 78645?
Document the suspected shunt problem, the shunt evaluated, radiotracer administration, the imaging performed, and the interpreting clinician’s findings about tracer progression.
Is this the right code for locating a CSF leak?
No. 78645 evaluates an implanted shunt; code 78650 is associated with CSF leak imaging.
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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