Billing code 78130: Red-cell survivalMedicare rate & RVUs in Oregon
Reports a nuclear medicine study that tracks labeled red blood cells over time to assess their survival in patients with suspected shortened erythrocyte lifespan.
Medicare pays $125.81–$138.28 for 78130 in the office in Oregon, from Rest Of Oregon to Portland. 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 78130 covers
For this study, the patient’s red blood cells are labeled and returned to circulation, then evaluated through follow-up sampling to estimate how long they survive. It is used in investigations of suspected hemolysis or other causes of shortened red-cell lifespan. Nuclear medicine personnel perform the technical work, and a qualified physician interprets the results. The service may be provided through a hospital or other diagnostic testing setting that can manage cell labeling and serial assessment.
Report 78130 when the documented service evaluates red-cell survival, not simply red-cell quantity or the location of cell sequestration. The record should support the labeling and administration of the cells, the survival assessment, and the physician’s interpretation and report. CMS recognizes a professional component for interpretation and a technical component for equipment and staff: report modifier 26 for the interpretation, modifier TC for the technical service, or neither modifier for the global service when one entity provides both components.
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 78130 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $138.28 | Unavailable |
| Rest Of Oregon | $125.81 | Unavailable |
How the 78130 rate is calculated
Each of 78130’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 · 78130
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.59Practice expense 3.14Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78130
The CMS indicators that decide how 78130 is paid alongside other services.
CMS payment indicators · 78130
Red-cell survival
| 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
78130 without 26 · national office
$126.92
Red-cell survival
78130-26 · Professional component
$23.71
Pays only the interpretation and report.
78130 compared with similar codes
Compare codes
78130 vs 78140 vs 78120 vs 78191: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 78140Red-cell study
- 78130 evaluates how long red cells survive; 78140 evaluates red-cell sequestration. Use the code for the study actually performed and documented.
- 78120Red cell mass
- 78120 measures red-cell mass in a single determination. Choose 78130 when the test evaluates red-cell lifespan instead of the circulating red-cell quantity.
- 78191Platelet study
- 78191 evaluates platelet survival, while 78130 evaluates red-cell survival. The cell type studied determines the code.
78130 billing questions
How is 78130 different from a red-cell mass study?
78130 evaluates how long circulating red cells survive. Red-cell mass testing measures the amount of red-cell volume rather than cell lifespan.
When should modifier 26 or TC be used?
Use modifier 26 for the physician’s interpretation and report, and TC for the technical service. Report the global service without either modifier when both components are billed together.
Does 78130 include a red-cell sequestration study?
The survival assessment and sequestration assessment address different findings. Report 78130 for the survival work performed; the documentation should identify any separately performed sequestration study.
What documentation supports reporting 78130?
Document the red-cell labeling and administration, the survival assessment, and the interpretation. The record should establish that the test evaluates red-cell lifespan rather than mass alone.
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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