CPT code 78803: Tumor SPECT, single body area2026 Medicare rate & RVUs in Illinois
Reports radiopharmaceutical tumor localization with SPECT in one body area, such as the chest or pelvis, when functional imaging is performed.
Medicare pays $311.73–$346.52 for 78803 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. 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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What 78803 covers
This service uses a radiopharmaceutical and a gamma camera to create SPECT images that help localize tumor activity in one body area. A nuclear medicine physician interprets the study; imaging may be performed in a hospital department or outpatient imaging center. Examples of a single area include the chest, pelvis, or head and neck region.
Select this code when the study uses SPECT for one area; the number and location of imaged areas should be clear in the order and imaging report. The record should support the radiopharmaceutical study, the body area examined, the acquisition performed, and the physician’s interpretation. Report the global service without a component modifier, or separate the interpretation with modifier 26 from the equipment and staff component with modifier TC. When multiple diagnostic imaging procedures are performed, CMS multiple procedure reduction applies to both the professional and technical components.
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 78803 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$311.73 to $346.52
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $341.74 | Unavailable |
| East St. Louis, IL | $315.31 | Unavailable |
| Rest of Illinois | $311.73 | Unavailable |
| Suburban Chicago, IL | $346.52 | Unavailable |
How the 78803 rate is calculated
Each of 78803’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 · 78803
RVUs × geographic indexes × conversion factor
Work1.06
1.06 RVUs× 1.000 GPCI
Practice expense8.89
8.89 RVUs× 1.000 GPCI
Malpractice0.10
0.10 RVUs× 1.000 GPCI
Adjusted RVUs
10.0500
Conversion factor
$33.4009
Medicare rate
$335.68
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 78803
The CMS indicators that decide how 78803 is paid alongside other services.
CMS payment indicators · 78803
Tumor SPECT, single body area
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 4 | Diagnostic imaging reduction applies to the technical component (and professional component) of additional services. |
| 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
78803 without 26 · national office
$335.68
Tumor SPECT, single body area
78803-26 · Professional component
$49.10
Pays only the interpretation and report.
78803 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 78800Tumor imagingSingle area, one day
- Choose 78803 for SPECT localization in one area. Choose 78800 when tumor localization imaging is performed without SPECT.
- 78830Tumor SPECT/CTSingle imaging area
- 78830 includes SPECT with a concurrently acquired CT scan for anatomic localization; 78803 reports single-area SPECT without that CT component.
- 78831Tumor SPECTTwo or more areas
- 78803 is for SPECT localization in one area; 78831 is for studies covering two areas.
78803 billing questions
How does 78803 differ from 78800?
78803 describes SPECT imaging of one body area. 78800 is the related limited-area tumor localization code for imaging without SPECT.
When should 78830 be considered instead?
Use 78830 when the tumor localization study combines SPECT with a concurrently acquired CT scan for anatomic localization in one area.
Can the professional and technical services be billed separately?
Yes. Modifier 26 identifies the interpretation, and modifier TC identifies the equipment and staff component. Without either modifier, the claim represents the global service.
Does CMS apply a multiple procedure reduction to 78803?
Yes. When multiple diagnostic imaging procedures are performed, the reduction applies to both the professional and technical components.
What supports reporting one area?
The order and imaging report should identify the body area studied and document the SPECT acquisition and interpretation. Use a code for a different extent when the study covers multiple areas or the whole body.
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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