Billing code 78226: Hepatobiliary imagingMedicare rate & RVUs in Guam
Reports radiotracer imaging of bile flow through the liver and biliary system, including gallbladder visualization, for suspected obstruction, inflammation, or bile leak.
Medicare pays $318.97 for 78226 in the office in Guam (Hawaii, Guam). 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.
On this page 9 sections
What 78226 covers
This nuclear medicine study tracks an injected radiotracer as the liver takes it up and excretes it into the bile ducts, gallbladder when present, and bowel. A technologist acquires the gamma-camera images, and a radiologist or nuclear medicine physician interprets them. Common clinical questions include suspected acute cholecystitis, impaired bile flow, or a postoperative bile leak. The study is performed without the pharmacologic intervention represented by the related drug-assisted code.
Select this code for hepatobiliary imaging based on the documented study performed, not simply because the patient has a liver or gallbladder diagnosis. The order and report should support the clinical question and identify the imaging performed and findings. CMS recognizes separate professional and technical components: report modifier 26 for the interpretation, modifier TC for equipment and staff, or neither modifier when billing the global service. The CMS file separately prices modifiers 26 and TC.
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.
78226 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $318.97 | Unavailable |
How the 78226 rate is calculated
Each of 78226’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 · 78226
RVUs × geographic indexes × conversion factor
Work0.72
0.72 RVUs× 1.000 GPCI
Practice expense7.72
7.72 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
8.5300
Conversion factor
$33.4009
Medicare rate
$284.91
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 78226
The CMS indicators that decide how 78226 is paid alongside other services.
CMS payment indicators · 78226
Hepatobiliary 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
78226 without 26 · national office
$284.91
Hepatobiliary imaging
78226-26 · Professional component
$33.73
Pays only the interpretation and report.
78226 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 78227Hepatobiliary scan
- Both address hepatobiliary imaging, but 78227 is for a study with pharmacologic intervention; 78226 is for imaging without it.
- 78201Liver imaging
- 78201 is static liver imaging. Choose 78226 when the study follows tracer through the hepatobiliary system, including gallbladder visualization when performed.
- 78202Liver imaging
- 78202 adds vascular-flow assessment to liver imaging. It is not the hepatobiliary transit study described by 78226.
78226 billing questions
When should 78227 be used instead?
Use 78227 when the hepatobiliary study includes a pharmacologic intervention. Use 78226 for the corresponding imaging without that intervention.
Is this the code for a HIDA scan?
It commonly describes a HIDA-type hepatobiliary study that follows radiotracer through the liver and biliary system. Confirm that the performed study does not include the drug intervention associated with 78227.
How should the professional and technical portions be billed?
Use modifier 26 for the professional interpretation and modifier TC for the technical service. Billing without either modifier represents the global service.
What documentation supports reporting 78226?
The record should identify the clinical question, the hepatobiliary imaging performed, and the interpreting findings. The report should make clear whether pharmacologic intervention was part of the study.
Is 78226 the same as liver-only imaging?
No. 78226 evaluates radiotracer movement through the hepatobiliary system; 78201 is for static liver imaging, and 78202 includes vascular-flow 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 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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