Billing code 78291: Shunt imagingMedicare rate & RVUs
Nuclear medicine imaging tracks peritoneal tracer passage through an existing peritoneovenous shunt when impaired flow or shunt patency is in question.
Medicare pays $232.80 for 78291 nationally in the office. Local office rates run $202.99–$323.44.
Medicare rate · 78291
Shunt imaging
Swap in your local Medicare rate.
- Work RVUs
- 0.86
- Total RVUs
- 6.97
- Global days
- XXX
National rate · 2026
$232.80
Office setting, before claim adjustments.
See every locality for 78291 → · Billed by an NP, PA or therapist? →
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 9 sections
What 78291 covers
This nuclear medicine study evaluates whether an existing peritoneovenous shunt is open and conveying peritoneal fluid into the venous circulation. A radiotracer is introduced into the peritoneal cavity, and imaging tracks its passage through the shunt. The study may be ordered for a patient with ascites when shunt flow is questioned. A nuclear medicine technologist performs image acquisition, and a nuclear medicine physician interprets the findings, typically in a hospital imaging department.
Report 78291 for the shunt-patency study, supported by documentation of the indication, the tracer administration and imaging performed, and the interpretation. Submit modifier 26 for the physician interpretation or modifier TC for the equipment and staff portion when billing those components separately. Without either modifier, the code represents the global service. The CMS facts supplied for this code identify separately priced 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 78291 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$202.99 to $323.44
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $206.37 | Unavailable |
| Alaska* | $258.89 | Unavailable |
| Arizona | $226.14 | Unavailable |
| Arkansas | $202.99 | Unavailable |
| Atlanta | $236.71 | Unavailable |
| Austin | $244.18 | Unavailable |
| Bakersfield | $251.48 | Unavailable |
| Baltimore/Surr. Cntys | $248.65 | Unavailable |
| Beaumont | $214.49 | Unavailable |
| Brazoria | $230.56 | Unavailable |
| Chicago | $237.90 | Unavailable |
| Chico | $251.20 | Unavailable |
| Colorado | $245.36 | Unavailable |
| Connecticut | $249.49 | Unavailable |
| Dallas | $231.83 | Unavailable |
| Dc + Md/Va Suburbs | $270.49 | Unavailable |
| Delaware | $230.23 | Unavailable |
| Detroit | $227.83 | Unavailable |
| East St. Louis | $219.77 | Unavailable |
| El Centro | $251.22 | Unavailable |
| Fort Lauderdale | $237.85 | Unavailable |
| Fort Worth | $229.86 | Unavailable |
| Fresno | $251.20 | Unavailable |
| Galveston | $231.11 | Unavailable |
| Hanford-Corcoran | $251.20 | Unavailable |
| Hawaii, Guam | $259.09 | Unavailable |
| Houston | $232.76 | Unavailable |
| Idaho | $215.13 | Unavailable |
| Indiana | $216.58 | Unavailable |
| Iowa | $213.90 | Unavailable |
| Kansas | $212.01 | Unavailable |
| Kentucky | $210.23 | Unavailable |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $269.77 | Unavailable |
| Madera | $251.20 | Unavailable |
| Manhattan | $268.98 | Unavailable |
| Merced | $251.20 | Unavailable |
| Metropolitan Boston | $272.66 | Unavailable |
| Metropolitan Kansas City | $220.47 | Unavailable |
| Metropolitan Philadelphia | $242.15 | Unavailable |
| Metropolitan St. Louis | $223.16 | Unavailable |
| Miami | $245.64 | Unavailable |
| Minnesota | $236.52 | Unavailable |
| Mississippi | $204.07 | Unavailable |
| Modesto | $251.20 | Unavailable |
| Montana** | $232.80 | Unavailable |
| Napa | $297.08 | Unavailable |
| Nebraska | $215.45 | Unavailable |
| Nevada** | $232.50 | Unavailable |
| New Hampshire | $240.67 | Unavailable |
| New Mexico | $216.72 | Unavailable |
| New Orleans | $221.35 | Unavailable |
| North Carolina | $218.25 | Unavailable |
| North Dakota** | $231.02 | Unavailable |
| Northern Nj | $266.99 | Unavailable |
| Nyc Suburbs/Long Island | $275.22 | Unavailable |
| Ohio | $215.33 | Unavailable |
| Oklahoma | $210.62 | Unavailable |
| Oxnard-Thousand Oaks-Ventura | $269.07 | Unavailable |
| Portland | $254.81 | Unavailable |
| Poughkpsie/N Nyc Suburbs | $253.83 | Unavailable |
| Puerto Rico | $234.97 | Unavailable |
| Queens | $272.57 | Unavailable |
| Redding | $251.20 | Unavailable |
| Rest Of California | $251.20 | Unavailable |
| Rest Of Florida | $225.47 | Unavailable |
| Rest Of Georgia | $211.67 | Unavailable |
| Rest Of Illinois | $217.00 | Unavailable |
| Rest Of Louisiana | $209.55 | Unavailable |
| Rest Of Maine | $215.58 | Unavailable |
| Rest Of Maryland | $235.26 | Unavailable |
| Rest Of Massachusetts | $243.31 | Unavailable |
| Rest Of Michigan | $215.70 | Unavailable |
| Rest Of Missouri | $204.98 | Unavailable |
| Rest Of New Jersey | $252.74 | Unavailable |
| Rest Of New York | $221.86 | Unavailable |
| Rest Of Oregon | $231.11 | Unavailable |
| Rest Of Pennsylvania | $216.15 | Unavailable |
| Rest Of Texas | $222.26 | Unavailable |
| Rest Of Washington | $243.12 | Unavailable |
| Rhode Island | $239.66 | Unavailable |
| Riverside-San Bernardino-Ontario | $252.18 | Unavailable |
| Sacramento-Roseville-Folsom | $265.22 | Unavailable |
| Salinas | $264.27 | Unavailable |
| San Diego-Chula Vista-Carlsbad | $271.70 | Unavailable |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $316.35 | Unavailable |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $316.24 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $323.44 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $323.03 | Unavailable |
| San Luis Obispo-Paso Robles | $259.85 | Unavailable |
| Santa Cruz-Watsonville | $275.24 | Unavailable |
| Santa Maria-Santa Barbara | $265.59 | Unavailable |
| Santa Rosa-Petaluma | $278.12 | Unavailable |
| Seattle (King Cnty) | $279.33 | Unavailable |
| South Carolina | $217.07 | Unavailable |
| South Dakota** | $230.81 | Unavailable |
| Southern Maine | $229.89 | Unavailable |
| Stockton | $251.20 | Unavailable |
| Suburban Chicago | $240.76 | Unavailable |
| Tennessee | $213.11 | Unavailable |
| Utah | $220.43 | Unavailable |
| Vallejo | $296.93 | Unavailable |
| Vermont | $229.31 | Unavailable |
| Virgin Islands | $234.97 | Unavailable |
| Virginia | $228.50 | Unavailable |
| Visalia | $251.20 | Unavailable |
| West Virginia | $207.76 | Unavailable |
| Wisconsin | $222.28 | Unavailable |
| Wyoming** | $232.02 | Unavailable |
| Yuba City | $251.20 | Unavailable |
78291 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.
$202.99
$287.32
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 | $258.89 | 1 |
| AL | $206.37 | 1 |
| AR | $202.99 | 1 |
| AZ | $226.14 | 1 |
| CA | $251.20–$323.44 | 29 |
| CO | $245.36 | 1 |
| CT | $249.49 | 1 |
| DC | $270.49 | 1 |
| DE | $230.23 | 1 |
| FL | $225.47–$245.64 | 3 |
| GA | $211.67–$236.71 | 2 |
| GU | $259.09 | 1 |
| HI | $259.09 | 1 |
| IA | $213.90 | 1 |
| ID | $215.13 | 1 |
| IL | $217.00–$240.76 | 4 |
| IN | $216.58 | 1 |
| KS | $212.01 | 1 |
| KY | $210.23 | 1 |
| LA | $209.55–$221.35 | 2 |
| MA | $243.31–$272.66 | 2 |
| MD | $235.26–$270.49 | 3 |
| ME | $215.58–$229.89 | 2 |
| MI | $215.70–$227.83 | 2 |
| MN | $236.52 | 1 |
| MO | $204.98–$223.16 | 3 |
| MS | $204.07 | 1 |
| MT | $232.80 | 1 |
| NC | $218.25 | 1 |
| ND | $231.02 | 1 |
| NE | $215.45 | 1 |
| NH | $240.67 | 1 |
| NJ | $252.74–$266.99 | 2 |
| NM | $216.72 | 1 |
| NV | $232.50 | 1 |
| NY | $221.86–$275.22 | 5 |
| OH | $215.33 | 1 |
| OK | $210.62 | 1 |
| OR | $231.11–$254.81 | 2 |
| PA | $216.15–$242.15 | 2 |
| PR | $234.97 | 1 |
| RI | $239.66 | 1 |
| SC | $217.07 | 1 |
| SD | $230.81 | 1 |
| TN | $213.11 | 1 |
| TX | $214.49–$244.18 | 8 |
| UT | $220.43 | 1 |
| VA | $228.50–$270.49 | 2 |
| VI | $234.97 | 1 |
| VT | $229.31 | 1 |
| WA | $243.12–$279.33 | 2 |
| WI | $222.28 | 1 |
| WV | $207.76 | 1 |
| WY | $232.02 | 1 |
How the 78291 rate is calculated
Each of 78291’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 · 78291
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.86Practice expense 6.02Malpractice 0.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78291
The CMS indicators that decide how 78291 is paid alongside other services.
CMS payment indicators · 78291
Shunt imaging
| 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
78291 without 26 · national office
$232.80
Shunt imaging
78291-26 · Professional component
$40.75
Pays only the interpretation and report.
78291 compared with similar codes
Compare codes
78291 vs 78290 vs 78299: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 78290Intestinal imaging
- 78290 is for intestine imaging. Choose 78291 when the diagnostic target is flow through an existing peritoneovenous shunt.
- 78299Unlisted gi px dx nuc med
- 78299 is an unlisted GI diagnostic nuclear medicine code. 78291 is the specific code for peritoneovenous shunt patency imaging.
78291 billing questions
When should 78291 be selected instead of 78290?
Use 78291 when imaging evaluates flow through an existing peritoneovenous shunt. Code 78290 describes intestine imaging, not shunt patency.
Which modifiers identify the separate components?
Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service. Billing without a component modifier represents the global service.
What documentation supports reporting 78291?
Document the clinical concern about the existing shunt, tracer administration, imaging performed, and the physician's interpretation of tracer passage.
Can this code be reported for shunt placement?
No. 78291 describes imaging to assess shunt patency, not the procedure to place a peritoneovenous shunt.
Should 78299 be used for a peritoneovenous shunt patency study?
78291 specifically describes this study. 78299 is an unlisted GI diagnostic nuclear medicine code, not the code for a defined shunt-patency examination.
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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