Billing code 78130: Red-cell survivalMedicare rate & RVUs

Medicare pays $126.92 for 78130 nationally in the office. Local office rates run $111.00–$174.36.

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

What 78130 covers

For this study, the patient’s red blood cells are labeled and returned to circulation, then evaluated through follow-up sampling to estimate how long they survive. It is used in investigations of suspected hemolysis or other causes of shortened red-cell lifespan. Nuclear medicine personnel perform the technical work, and a qualified physician interprets the results. The service may be provided through a hospital or other diagnostic testing setting that can manage cell labeling and serial assessment.

Report 78130 when the documented service evaluates red-cell survival, not simply red-cell quantity or the location of cell sequestration. The record should support the labeling and administration of the cells, the survival assessment, and the physician’s interpretation and report. CMS recognizes a professional component for interpretation and a technical component for equipment and staff: report modifier 26 for the interpretation, modifier TC for the technical service, or neither modifier for the global service when one entity provides both 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 78130 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

78130 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 78130 rate is calculated

Each of 78130’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.

Payment rules and modifiers for 78130

The CMS indicators that decide how 78130 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

78130 compared with similar codes

How to choose

78140Red-cell study

78130 evaluates how long red cells survive; 78140 evaluates red-cell sequestration. Use the code for the study actually performed and documented.

78120Red cell mass

78120 measures red-cell mass in a single determination. Choose 78130 when the test evaluates red-cell lifespan instead of the circulating red-cell quantity.

78191Platelet study

78191 evaluates platelet survival, while 78130 evaluates red-cell survival. The cell type studied determines the code.

Codes related to 78130

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

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

Open CMS sourceHow we calculate rates