CPT code 79200: Radiopharmaceutical therapy2026 Medicare rate & RVUs in Illinois
Report this service for therapeutic administration of a radiopharmaceutical into an artery, rather than by oral, intravenous, or intracavitary route.
Medicare pays $125.96–$134.07 for 79200 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 79200 covers
This service represents therapeutic delivery of a radioactive drug directly into an artery. It is associated with targeted treatment in which the agent is administered through an arterial route; nuclear medicine physicians and physicians performing image-guided arterial procedures may be involved. The code identifies the administration route, not simply the presence of a radioactive substance or a diagnostic nuclear medicine study.
Choose the code when the documented therapeutic administration is intra-arterial, and retain the treatment record showing the radiopharmaceutical and route. CMS identifies separately billable professional and technical components: modifier 26 represents the professional interpretation, modifier TC represents equipment and staff, and reporting without either modifier represents the global service. The CMS file lists both modifiers as separately priced. Do not select this code for oral, intravenous, intracavitary, or intra-arterial particulate administration when a more specific route or technique code describes the 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 79200 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
$125.96 to $134.07
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $133.53 | Unavailable |
| East St. Louis | $127.16 | Unavailable |
| Rest Of Illinois | $125.96 | Unavailable |
| Suburban Chicago | $134.07 | Unavailable |
How the 79200 rate is calculated
Each of 79200’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 · 79200
RVUs × geographic indexes × conversion factor
Work1.94
1.94 RVUs× 1.000 GPCI
Practice expense1.92
1.92 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
3.9100
Conversion factor
$33.4009
Medicare rate
$130.60
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 79200
The CMS indicators that decide how 79200 is paid alongside other services.
CMS payment indicators · 79200
Radiopharmaceutical therapy
| 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
79200 without 26 · national office
$130.60
Radiopharmaceutical therapy
79200-26 · Professional component
$77.49
Pays only the interpretation and report.
79200 compared with similar codes
Compare codes · National
79200 vs 79445 vs 79101: Medicare rates
How to choose
- 79445Nuclear rx intra-arterial
- Both describe intra-arterial radiopharmaceutical therapy, but 79445 specifies particulate administration. Select based on the documented treatment technique.
- 79101Radiopharmaceutical therapy
- 79101 applies to therapeutic administration through a vein; this code applies when the radiopharmaceutical is administered into an artery.
79200 billing questions
How is this code distinguished from 79445?
This code represents intra-arterial radiopharmaceutical therapy generally. Use 79445 when the documented therapy is specifically by intra-arterial particulate administration.
Can the professional and technical portions be billed separately?
Yes. CMS lists modifier 26 for the professional interpretation and modifier TC for the technical portion, which includes equipment and staff. Without either modifier, the claim represents the global service.
What documentation supports the intra-arterial route?
The treatment record should identify the radiopharmaceutical and document that it was administered into an artery for therapy. A diagnostic study showing arterial anatomy alone does not establish this service.
Should this code be used for intravenous radiopharmaceutical therapy?
No. For therapeutic administration by the intravenous route, 79101 is the route-specific alternative.
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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