$308.43
Both use SPECT for tumor localization, but 78803 is for one area; this code is for two or more.
On this page
CMS RVU26D · Effective 2026-10-01
78831 Tumor SPECT Medicare reimbursement rates in Iowa
Reports radiopharmaceutical tumor imaging with SPECT across two or more areas when tomographic views are used to localize or assess tumor involvement. Compare 78831 office and facility rates across CMS payment localities in Iowa.
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 78831 in Iowa?
Iowa 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
$572.23
1 of 1 localities have a supported rate.
Payment area: Iowa
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 78831: Tumor localization SPECT, multiple areas
Reports radiopharmaceutical tumor imaging with SPECT across two or more areas when tomographic views are used to localize or assess tumor involvement.
This service uses a radiopharmaceutical and single-photon emission computed tomography (SPECT) to show tumor-related uptake in two or more areas. Nuclear medicine departments commonly perform the acquisition, and a qualified physician interprets the study for an oncologic workup, such as evaluating suspected tumor distribution or recurrence. The code represents SPECT imaging without the CT component specified by related SPECT/CT codes.
Select this service when the imaging covers at least two areas and includes SPECT; distinguish the count and imaging method from single-area SPECT, SPECT/CT, and planar tumor-localization services. The record should support the clinical reason for imaging, the areas examined, the radiopharmaceutical study performed, and the physician’s interpretation. Report modifier 26 for the professional interpretation or modifier TC for the technical service; reporting without either modifier represents the global service, including both components.
CMS billing rules for 78831
- 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 RVU1.77 · 9%
- Practice expense (office) RVU16.72 · 90%
- Malpractice RVU0.16 · 1%
1.2K
Medicare services in 2024 · #2872 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.
78831 compared with similar codes
Office rates for Iowa, from the same CMS release.
$726.47
This code describes SPECT across two or more areas without CT. Choose 78832 when the study includes CT.
$220.37
Both cover tumor-localization imaging of two or more areas, but 78801 is planar imaging rather than SPECT.
Compare 78831 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
Iowa →
Office / nonfacility
$572.23
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 78831 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
9,549
- Code
- 78831
- Physician work
- 1.77
- Practice expense
- 16.72
- Malpractice
- 0.16
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.77 | × 1.000 | 1.7700 |
| Practice expense | 16.72 | × 0.915 | 15.2988 |
| Malpractice | 0.16 | × 0.397 | 0.0635 |
| Total RVUs | 17.1323 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$572.23
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.77 | 1 |
| Practice expense | 16.72 | 0.915 |
| Malpractice | 0.16 | 0.397 |
(1.77 × 1 + 16.72 × 0.915 + 0.16 × 0.397) × $33.4009 = $572.23
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.
78831 billing questions
When should this be reported instead of 78803?
Use 78831 when SPECT tumor imaging covers two or more areas. Code 78803 is for SPECT imaging of one area.
How does this differ from 78832?
Both describe tumor-localization SPECT across two or more areas, but 78832 includes CT. This code describes SPECT without that CT component.
Can the professional and technical services be billed separately?
Yes. Modifier 26 identifies the interpretation, and modifier TC identifies the equipment and staff service. Without either modifier, the claim represents the global service.
What documentation supports reporting two or more areas?
Document the clinical indication, the areas imaged, the SPECT study performed, and the interpreting physician’s findings. The record should make clear that the examination covered at least two areas.
Is this the right code for planar imaging of multiple areas?
No. This code is for SPECT. Code 78801 describes planar tumor-localization imaging of two or more areas.
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.
9,54678830,,Rp loclzj tum spect w/ct 1,A,,1.45,11.03,,11.03,NA,0.12,12.60,12.60,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,39.82,39.82,0.28
9,54778830,26,Rp loclzj tum spect w/ct 1,A,,1.45,0.44,,0.44,,0.06,1.95,1.95,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,54878830,TC,Rp loclzj tum spect w/ct 1,A,,0.00,10.59,,10.59,NA,0.06,10.65,10.65,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,39.38,39.38,0.22
9,54978831,,Rp loclzj tum spect 2 areas,A,,1.77,16.72,,16.72,NA,0.16,18.65,18.65,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,39.97,39.97,0.28
9,55078831,26,Rp loclzj tum spect 2 areas,A,,1.77,0.57,,0.57,,0.08,2.42,2.42,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,55178831,TC,Rp loclzj tum spect 2 areas,A,,0.00,16.15,,16.15,NA,0.08,16.23,16.23,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,39.40,39.40,0.20
9,55278832,,Rp loclzj tum spect w/ct 2,A,,2.07,21.43,,21.43,NA,0.18,23.68,23.68,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,44.20,44.20,0.28
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136