Billing code 78660: Tear-flow imagingMedicare rate & RVUs
Tracks radioactive tracer through the tear drainage pathways to evaluate impaired lacrimal flow, including suspected obstruction causing persistent tearing.
Medicare pays $132.60 for 78660 nationally in the office. Local office rates run $115.78–$183.93.
Medicare rate · 78660
Tear-flow imaging
Swap in your local Medicare rate.
- Work RVUs
- 0.52
- Total RVUs
- 3.97
- Global days
- XXX
National rate · 2026
$132.60
Office setting, before claim adjustments.
See every locality for 78660 → · 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 10 sections
What 78660 covers
This nuclear medicine study follows tear drainage from the eye through the lacrimal pathways toward the nose. A radioactive tracer is placed in the tear film, and gamma camera images show its movement over time. It may be used when persistent tearing raises concern for impaired drainage. The study is typically performed in a hospital or imaging department by nuclear medicine staff, with a physician interpreting the images; ophthalmologists commonly evaluate the resulting findings alongside the eye examination.
Report the service when imaging of lacrimal tracer flow is performed, rather than a mechanical probing or irrigation procedure. Documentation should identify the clinical concern, the imaging performed, and the interpreted drainage findings. CMS recognizes a professional component for interpretation and a technical component for equipment and staff: report modifier 26 for the professional service or TC for the technical service. Reporting without either modifier represents 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.
Where 78660 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
$115.78 to $183.93
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $117.68 | Unavailable |
| Alaska* | $147.92 | Unavailable |
| Arizona | $128.84 | Unavailable |
| Arkansas | $115.78 | Unavailable |
| Atlanta | $134.81 | Unavailable |
| Austin | $139.03 | Unavailable |
| Bakersfield | $143.18 | Unavailable |
| Baltimore/Surr. Cntys | $141.57 | Unavailable |
| Beaumont | $122.26 | Unavailable |
| Brazoria | $131.35 | Unavailable |
| Chicago | $135.45 | Unavailable |
| Chico | $143.02 | Unavailable |
| Colorado | $139.71 | Unavailable |
| Connecticut | $142.04 | Unavailable |
| Dallas | $132.07 | Unavailable |
| Dc + Md/Va Suburbs | $153.94 | Unavailable |
| Delaware | $131.16 | Unavailable |
| Detroit | $129.77 | Unavailable |
| East St. Louis | $125.21 | Unavailable |
| El Centro | $143.03 | Unavailable |
| Fort Lauderdale | $135.43 | Unavailable |
| Fort Worth | $130.95 | Unavailable |
| Fresno | $143.02 | Unavailable |
| Galveston | $131.66 | Unavailable |
| Hanford-Corcoran | $143.02 | Unavailable |
| Hawaii, Guam | $147.46 | Unavailable |
| Houston | $132.57 | Unavailable |
| Idaho | $122.64 | Unavailable |
| Indiana | $123.45 | Unavailable |
| Iowa | $121.94 | Unavailable |
| Kansas | $120.87 | Unavailable |
| Kentucky | $119.85 | Unavailable |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $153.53 | Unavailable |
| Madera | $143.02 | Unavailable |
| Manhattan | $153.09 | Unavailable |
| Merced | $143.02 | Unavailable |
| Metropolitan Boston | $155.16 | Unavailable |
| Metropolitan Kansas City | $125.64 | Unavailable |
| Metropolitan Philadelphia | $137.89 | Unavailable |
| Metropolitan St. Louis | $127.15 | Unavailable |
| Miami | $139.81 | Unavailable |
| Minnesota | $134.72 | Unavailable |
| Mississippi | $116.38 | Unavailable |
| Modesto | $143.02 | Unavailable |
| Montana** | $132.60 | Unavailable |
| Napa | $168.99 | Unavailable |
| Nebraska | $122.82 | Unavailable |
| Nevada** | $132.44 | Unavailable |
| New Hampshire | $137.05 | Unavailable |
| New Mexico | $123.51 | Unavailable |
| New Orleans | $126.13 | Unavailable |
| North Carolina | $124.39 | Unavailable |
| North Dakota** | $131.61 | Unavailable |
| Northern Nj | $151.98 | Unavailable |
| Nyc Suburbs/Long Island | $156.61 | Unavailable |
| Ohio | $122.73 | Unavailable |
| Oklahoma | $120.08 | Unavailable |
| Oxnard-Thousand Oaks-Ventura | $153.13 | Unavailable |
| Portland | $145.06 | Unavailable |
| Poughkpsie/N Nyc Suburbs | $144.52 | Unavailable |
| Puerto Rico | $133.83 | Unavailable |
| Queens | $155.12 | Unavailable |
| Redding | $143.02 | Unavailable |
| Rest Of California | $143.02 | Unavailable |
| Rest Of Florida | $128.44 | Unavailable |
| Rest Of Georgia | $120.66 | Unavailable |
| Rest Of Illinois | $123.66 | Unavailable |
| Rest Of Louisiana | $119.47 | Unavailable |
| Rest Of Maine | $122.89 | Unavailable |
| Rest Of Maryland | $134.00 | Unavailable |
| Rest Of Massachusetts | $138.56 | Unavailable |
| Rest Of Michigan | $122.94 | Unavailable |
| Rest Of Missouri | $116.89 | Unavailable |
| Rest Of New Jersey | $143.91 | Unavailable |
| Rest Of New York | $126.43 | Unavailable |
| Rest Of Oregon | $131.65 | Unavailable |
| Rest Of Pennsylvania | $123.20 | Unavailable |
| Rest Of Texas | $126.65 | Unavailable |
| Rest Of Washington | $138.45 | Unavailable |
| Rhode Island | $136.50 | Unavailable |
| Riverside-San Bernardino-Ontario | $143.57 | Unavailable |
| Sacramento-Roseville-Folsom | $150.96 | Unavailable |
| Salinas | $150.42 | Unavailable |
| San Diego-Chula Vista-Carlsbad | $154.62 | Unavailable |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $179.91 | Unavailable |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $179.85 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $183.93 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $183.70 | Unavailable |
| San Luis Obispo-Paso Robles | $147.91 | Unavailable |
| Santa Cruz-Watsonville | $156.61 | Unavailable |
| Santa Maria-Santa Barbara | $151.16 | Unavailable |
| Santa Rosa-Petaluma | $158.24 | Unavailable |
| Seattle (King Cnty) | $158.94 | Unavailable |
| South Carolina | $123.72 | Unavailable |
| South Dakota** | $131.49 | Unavailable |
| Southern Maine | $130.96 | Unavailable |
| Stockton | $143.02 | Unavailable |
| Suburban Chicago | $137.08 | Unavailable |
| Tennessee | $121.49 | Unavailable |
| Utah | $125.62 | Unavailable |
| Vallejo | $168.91 | Unavailable |
| Vermont | $130.64 | Unavailable |
| Virgin Islands | $133.83 | Unavailable |
| Virginia | $130.18 | Unavailable |
| Visalia | $143.02 | Unavailable |
| West Virginia | $118.44 | Unavailable |
| Wisconsin | $126.68 | Unavailable |
| Wyoming** | $132.17 | Unavailable |
| Yuba City | $143.02 | Unavailable |
78660 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.
$115.78
$163.48
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 | $147.92 | 1 |
| AL | $117.68 | 1 |
| AR | $115.78 | 1 |
| AZ | $128.84 | 1 |
| CA | $143.02–$183.93 | 29 |
| CO | $139.71 | 1 |
| CT | $142.04 | 1 |
| DC | $153.94 | 1 |
| DE | $131.16 | 1 |
| FL | $128.44–$139.81 | 3 |
| GA | $120.66–$134.81 | 2 |
| GU | $147.46 | 1 |
| HI | $147.46 | 1 |
| IA | $121.94 | 1 |
| ID | $122.64 | 1 |
| IL | $123.66–$137.08 | 4 |
| IN | $123.45 | 1 |
| KS | $120.87 | 1 |
| KY | $119.85 | 1 |
| LA | $119.47–$126.13 | 2 |
| MA | $138.56–$155.16 | 2 |
| MD | $134.00–$153.94 | 3 |
| ME | $122.89–$130.96 | 2 |
| MI | $122.94–$129.77 | 2 |
| MN | $134.72 | 1 |
| MO | $116.89–$127.15 | 3 |
| MS | $116.38 | 1 |
| MT | $132.60 | 1 |
| NC | $124.39 | 1 |
| ND | $131.61 | 1 |
| NE | $122.82 | 1 |
| NH | $137.05 | 1 |
| NJ | $143.91–$151.98 | 2 |
| NM | $123.51 | 1 |
| NV | $132.44 | 1 |
| NY | $126.43–$156.61 | 5 |
| OH | $122.73 | 1 |
| OK | $120.08 | 1 |
| OR | $131.65–$145.06 | 2 |
| PA | $123.20–$137.89 | 2 |
| PR | $133.83 | 1 |
| RI | $136.50 | 1 |
| SC | $123.72 | 1 |
| SD | $131.49 | 1 |
| TN | $121.49 | 1 |
| TX | $122.26–$139.03 | 8 |
| UT | $125.62 | 1 |
| VA | $130.18–$153.94 | 2 |
| VI | $133.83 | 1 |
| VT | $130.64 | 1 |
| WA | $138.45–$158.94 | 2 |
| WI | $126.68 | 1 |
| WV | $118.44 | 1 |
| WY | $132.17 | 1 |
How the 78660 rate is calculated
Each of 78660’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 · 78660
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.52Practice expense 3.40Malpractice 0.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78660
The CMS indicators that decide how 78660 is paid alongside other services.
CMS payment indicators · 78660
Tear-flow 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
78660 without 26 · national office
$132.60
Tear-flow imaging
78660-26 · Professional component
$20.71
Pays only the interpretation and report.
78660 compared with similar codes
Compare codes
78660 vs 68810 vs 68811 vs 68815: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 68810Tear duct probing
- Use 78660 for imaging that follows tracer through tear drainage. Use 68810 when the service is mechanical nasolacrimal duct probing, with or without irrigation.
- 68811Tear duct probing
- This code describes imaging of tear flow; 68811 describes nasolacrimal duct probing performed under general anesthesia.
- 68815Duct probing
- Use 78660 for diagnostic tracer imaging. Use 68815 when probing includes insertion of a tube into the drainage pathway.
78660 billing questions
When is this code appropriate instead of lacrimal probing?
Use this code for nuclear imaging that tracks tear flow. Probing or irrigation codes describe a mechanical procedure on the lacrimal drainage system.
How are the professional and technical services reported?
Use modifier 26 for the physician’s interpretation and TC for the technical service, including equipment and staff. Without either modifier, the claim represents the global service.
What documentation supports the service?
Document the concern prompting the study, the imaging performed, and the physician’s interpretation of tracer movement through the tear drainage pathways.
Does this code describe treatment of a blocked tear duct?
No. It describes diagnostic imaging of tear flow; probing, irrigation, or tube insertion are separate lacrimal procedures.
Can the professional and technical components be billed separately?
Yes. CMS separately prices the professional and technical components when reported with modifier 26 or TC, respectively.
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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