Billing code 78264: Gastric emptyingMedicare rate & RVUs in Illinois
Reports scintigraphic assessment of how quickly a radiolabeled meal leaves the stomach, commonly when symptoms raise concern for delayed gastric emptying.
Medicare pays $268.89–$299.47 for 78264 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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 78264 covers
A nuclear medicine team administers a radiolabeled meal and obtains serial images to track its passage out of the stomach. The study is commonly ordered for patients with nausea, vomiting, early satiety, or post-meal fullness when delayed gastric emptying is being evaluated. A nuclear medicine physician interprets the images; a technologist typically prepares the imaging equipment and acquires the study in a hospital or outpatient imaging department.
Report 78264 for the gastric-emptying assessment itself, rather than an examination that also evaluates transit through the small bowel or colon. The record should identify the meal or protocol used, document image acquisition, and include the physician’s interpretation of gastric emptying. CMS recognizes separately priced professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies the equipment and staff portion, and an unmodified claim 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 78264 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$268.89 to $299.47
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $295.30 | Unavailable |
| East St. Louis | $272.07 | Unavailable |
| Rest Of Illinois | $268.89 | Unavailable |
| Suburban Chicago | $299.47 | Unavailable |
How the 78264 rate is calculated
Each of 78264’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 · 78264
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.77Practice expense 7.82Malpractice 0.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78264
The CMS indicators that decide how 78264 is paid alongside other services.
CMS payment indicators · 78264
Gastric emptying
| 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
78264 without 26 · national office
$289.92
Gastric emptying
78264-26 · Professional component
$35.74
Pays only the interpretation and report.
78264 compared with similar codes
Compare codes
78264 vs 78265 vs 78266 vs 78262: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 78265Gastric emptying
- 78264 assesses gastric emptying alone; 78265 includes assessment of small-bowel transit as well.
- 78266GI transit imaging
- 78266 extends the transit assessment through the small bowel and colon, beyond the stomach-only focus of 78264.
- 78262Reflux imaging
- 78262 evaluates gastroesophageal reflux. Choose 78264 when the question is how quickly the stomach empties.
78264 billing questions
When should 78264 be chosen over 78265?
Use 78264 when the study assesses gastric emptying alone. Choose 78265 when the examination also evaluates small-bowel transit.
How should the professional and technical services be reported?
Append modifier 26 for the physician’s interpretation or modifier TC for the equipment and staff portion. Report the global service without either modifier.
What documentation supports this code?
Document the gastric-emptying protocol and meal, image acquisition, and the interpreting physician’s findings. The report should make clear that the examination evaluates stomach emptying rather than downstream transit.
Can this code be used when small-bowel or colon transit is also assessed?
Use the code that reflects the full study performed: 78265 includes small-bowel transit, and 78266 includes small-bowel and colon transit with gastric emptying.
Does 78264 represent a single image or the gastric-emptying examination?
It represents the gastric-emptying imaging study, which uses serial images to assess passage of the meal from the stomach.
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
Fee sheets
Put 78264 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →