Billing code 78835: Radiopharmaceutical quantificationMedicare rate & RVUs in Illinois
This add-on measurement quantifies radiopharmaceutical activity in one organ, lesion, or region during a related nuclear medicine localization study.
Medicare pays $84.02–$92.71 for 78835 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 78835 covers
Code 78835 captures quantitative measurement of radiopharmaceutical activity in one defined area, such as an organ, lesion, or region. It is reported with an eligible radiopharmaceutical localization study when the interpreting nuclear medicine physician quantifies activity beyond describing its location or appearance. The service may involve image processing and measurement from the study’s acquired data; the imaging team typically includes a nuclear medicine technologist and a physician who interprets the results.
Report one unit for each separately quantified area, and pair the add-on with the applicable primary localization procedure. The record should identify the area measured and include the quantitative findings and interpretation. This code is not reported by itself; CMS pays it within the primary procedure’s global period. The diagnostic service has professional and technical components: modifier 26 identifies the physician’s interpretation, modifier TC identifies the equipment and staff, and no component 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 78835 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
$84.02 to $92.71
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $91.62 | Unavailable |
| East St. Louis | $84.99 | Unavailable |
| Rest Of Illinois | $84.02 | Unavailable |
| Suburban Chicago | $92.71 | Unavailable |
How the 78835 rate is calculated
Each of 78835’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 · 78835
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.46Practice expense 2.20Malpractice 0.03
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78835
The CMS indicators that decide how 78835 is paid alongside other services.
CMS payment indicators · 78835
Radiopharmaceutical quantification
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| 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
78835 without 26 · national office
$89.85
Radiopharmaceutical quantification
78835-26 · Professional component
$21.38
Pays only the interpretation and report.
78835 compared with similar codes
Compare codes
78835 vs 78800 vs 78803 vs 78830: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 78800Tumor imaging
- 78800 reports the limited-area planar localization study. Use 78835 as an add-on only when a defined area from an eligible primary study is quantitatively measured.
- 78803Tumor SPECT
- 78803 reports SPECT tumor localization, while 78835 reports quantitative measurement of activity in an area alongside an eligible localization study.
- 78830Tumor SPECT/CT
- 78830 reports SPECT/CT tumor localization in one area. It describes the primary imaging service, not the additional quantification captured by 78835.
78835 billing questions
When is 78835 reported with a localization study?
Report it when a related radiopharmaceutical localization study includes quantitative measurement of activity in a specific area. It supplements the primary imaging service rather than replacing it.
How many units should be reported?
Report one unit for each single area quantified. The documentation should identify each measured organ, lesion, or region.
Can 78835 be billed by itself?
No. It is an add-on code and must be billed with an eligible primary radiopharmaceutical localization procedure.
Which modifiers identify the components?
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 this code?
Document the primary localization study, the area or areas quantified, the measurement results, and the physician’s interpretation.
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 78835 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 →