$291.14
Choose 78645 for radionuclide evaluation of an implanted shunt. Code 78630 addresses CSF circulation through cisternography.
On this page
CMS RVU26D · Effective 2026-10-01
78645 CSF shunt study Medicare reimbursement rates in Delaware
Nuclear medicine imaging tracks radiotracer movement through a cerebrospinal fluid shunt to investigate suspected impaired flow or shunt malfunction. Compare 78645 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 78645 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$281.90
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Nuclear medicine
About 78645: Radionuclide CSF shunt evaluation
Nuclear medicine imaging tracks radiotracer movement through a cerebrospinal fluid shunt to investigate suspected impaired flow or shunt malfunction.
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.
CMS billing rules for 78645
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
Where the value comes from
- Work RVU0.56 · 7%
- Practice expense (office) RVU7.90 · 93%
- Malpractice RVU0.08 · 1%
686
Medicare services in 2024 · #3285 by national volume
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.
78645 compared with similar codes
Office rates for Delaware, from the same CMS release.
$291.16
Code 78635 is directed at ventricular CSF imaging; 78645 follows tracer through a CSF shunt.
$242.35
Code 78650 is used for imaging directed at CSF leakage. Use 78645 when the clinical question concerns shunt flow or patency.
Compare 78645 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
$281.90
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 78645 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
9,470
- Code
- 78645
- Physician work
- 0.56
- Practice expense
- 7.90
- Malpractice
- 0.08
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.56 | × 1.005 | 0.5628 |
| Practice expense | 7.90 | × 0.988 | 7.8052 |
| Malpractice | 0.08 | × 0.899 | 0.0719 |
| Total RVUs | 8.4399 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$281.90
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.56 | 1.005 |
| Practice expense | 7.9 | 0.988 |
| Malpractice | 0.08 | 0.899 |
(0.56 × 1.005 + 7.9 × 0.988 + 0.08 × 0.899) × $33.4009 = $281.90
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
9,46778635,,Csf ventriculography,A,,0.59,8.15,,8.15,NA,0.08,8.82,8.82,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,16.72,16.72,0.13
9,46878635,26,Csf ventriculography,A,,0.59,0.22,,0.22,,0.03,0.84,0.84,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,46978635,TC,Csf ventriculography,A,,0.00,7.93,,7.93,NA,0.05,7.98,7.98,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,16.50,16.50,0.10
9,47078645,,Csf shunt evaluation,A,,0.56,7.90,,7.90,NA,0.08,8.54,8.54,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,16.68,16.68,0.14
9,47178645,26,Csf shunt evaluation,A,,0.56,0.18,,0.18,,0.03,0.77,0.77,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,47278645,TC,Csf shunt evaluation,A,,0.00,7.72,,7.72,NA,0.05,7.77,7.77,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,16.50,16.50,0.11
9,47378650,,Csf leakage imaging,A,,0.59,6.68,,6.68,NA,0.07,7.34,7.34,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,39.35,39.35,0.37
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503