Billing code 78804: Tumor localizationMedicare rate & RVUs in Oregon
Reports whole-body radiopharmaceutical tumor-localization imaging when image acquisition extends across two or more days for the diagnostic study.
Medicare pays $557.75–$618.72 for 78804 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 78804 covers
This code represents a nuclear medicine tumor-localization study in which a radiopharmaceutical is used to identify tumor-related activity throughout the body, with imaging performed on at least two days. Nuclear medicine technologists acquire the images, and a qualified physician interprets them. The service is typically performed in a hospital or outpatient nuclear medicine department when the diagnostic protocol calls for delayed or serial whole-body imaging rather than a single-day acquisition.
Select the code based on whole-body coverage and the multi-day imaging protocol, not simply the number of images. Documentation should identify the clinical indication, radiopharmaceutical, body coverage, imaging dates or timepoints, and the physician’s interpretation. CMS recognizes professional and technical components: report modifier 26 for the interpretation, modifier TC for the equipment and staff portion, or neither modifier for 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 78804 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $618.72 | Unavailable |
| Rest Of Oregon | $557.75 | Unavailable |
How the 78804 rate is calculated
Each of 78804’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 · 78804
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.98Practice expense 15.69Malpractice 0.13
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78804
The CMS indicators that decide how 78804 is paid alongside other services.
CMS payment indicators · 78804
Tumor localization
| 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
78804 without 26 · national office
$561.14
Tumor localization
78804-26 · Professional component
$45.09
Pays only the interpretation and report.
78804 compared with similar codes
Compare codes
78804 vs 78802 vs 78800 vs 78803: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 78802Tumor imaging
- Both describe whole-body tumor-localization imaging. Choose 78804 when imaging spans two or more days and 78802 when the study is performed on one day.
- 78800Tumor imaging
- 78800 is for one body area; 78804 is for whole-body imaging performed over two or more days.
- 78803Tumor SPECT
- 78803 identifies SPECT tumor-localization imaging. Choose 78804 for a multi-day whole-body study when the service is not reported as the SPECT procedure.
78804 billing questions
How does this differ from 78802?
78804 is for whole-body tumor-localization imaging performed over two or more days. Use 78802 when the whole-body study is completed on one day.
When should I choose 78800 or 78801 instead?
Those codes describe tumor-localization imaging of one area or multiple areas, rather than whole-body imaging. Choose according to the documented body coverage.
Can the professional and technical portions be billed separately?
Yes. Report modifier 26 for the physician’s interpretation or TC for the technical service; without either modifier, the claim represents the global service.
What documentation supports 78804?
Document the whole-body coverage, radiopharmaceutical, clinical indication, image-acquisition dates or timepoints, and the interpreting physician’s findings.
Is 78804 the right code for SPECT tumor imaging?
Use the applicable SPECT tumor-localization code when the service is SPECT-based. 78804 identifies a multi-day whole-body study, not SPECT imaging.
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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