$278.10
Choose 78650 when the study is specifically intended to find and localize a CSF leak. Choose 78630 for a cisternographic CSF study.
On this page
CMS RVU26D · Effective 2026-10-01
78650 CSF leak imaging Medicare reimbursement rates in Utah
Reports nuclear medicine imaging performed to detect and localize a suspected cerebrospinal fluid leak, such as leakage from the cranial or spinal CSF space. Compare 78650 office and facility rates across CMS payment localities in Utah.
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 78650 in Utah?
Utah 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
$231.54
1 of 1 localities have a supported rate.
Payment area: Utah
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 78650: Cerebrospinal fluid leak localization imaging
Reports nuclear medicine imaging performed to detect and localize a suspected cerebrospinal fluid leak, such as leakage from the cranial or spinal CSF space.
This nuclear medicine study traces cerebrospinal fluid to identify and localize a suspected leak. It may be used when a patient has signs of CSF leakage, including persistent clear drainage after head or spinal surgery or trauma. A radiologist or nuclear medicine physician interprets the resulting images; the technical service involves the imaging equipment and staff. The study is generally performed in a hospital or imaging department equipped for nuclear medicine procedures.
Select 78650 when the diagnostic purpose is finding and locating a CSF leak, rather than evaluating general CSF circulation, ventricular anatomy, or shunt function. Documentation should identify the suspected leak, the imaging procedure performed, and the physician’s interpretation and findings. Medicare recognizes professional and technical components: report modifier 26 for interpretation, modifier TC for equipment and staff, or no modifier for the global service when one entity provides both.
CMS billing rules for 78650
- 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 RVU0.59 · 8%
- Practice expense (office) RVU6.68 · 91%
- Malpractice RVU0.07 · 1%
27
Medicare services in 2024 · #5744 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.
78650 compared with similar codes
Office rates for Utah, from the same CMS release.
$269.14
78645 evaluates a CSF shunt; 78650 investigates suspected leakage from the CSF space.
$277.99
78635 is radiopharmaceutical ventriculography focused on the ventricular system. 78650 is directed at detecting and localizing CSF leakage.
Compare 78650 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
Utah →
Office / nonfacility
$231.54
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 78650 in Utah.
PPRRVU2026_Oct_nonQPP.csv
9,473
- Code
- 78650
- Physician work
- 0.59
- Practice expense
- 6.68
- Malpractice
- 0.07
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.59 | × 1.000 | 0.5900 |
| Practice expense | 6.68 | × 0.940 | 6.2792 |
| Malpractice | 0.07 | × 0.898 | 0.0629 |
| Total RVUs | 6.9321 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$231.54
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.59 | 1 |
| Practice expense | 6.68 | 0.94 |
| Malpractice | 0.07 | 0.898 |
(0.59 × 1 + 6.68 × 0.94 + 0.07 × 0.898) × $33.4009 = $231.54
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.
78650 billing questions
When should 78650 be chosen over 78630?
Use 78650 when the study is directed at detecting and localizing a CSF leak. Code 78630 describes cisternography when the purpose is a CSF cisternographic study rather than targeted leak localization.
How are the professional and technical services reported?
Report modifier 26 for the physician’s interpretation and modifier TC for the technical service. Report the code without a modifier when billing the global service.
What documentation supports 78650?
Document the clinical suspicion of a CSF leak, the imaging performed to locate it, and the interpreting physician’s findings. The record should make clear that leak detection or localization was the study’s purpose.
Is 78650 the code for evaluating a CSF shunt?
No. 78650 addresses suspected CSF leakage; 78645 is for evaluation of a CSF shunt.
Can the professional and technical components be billed separately?
Yes. Medicare identifies separately priced professional and technical components for this diagnostic test, reported with modifiers 26 and TC, respectively.
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.
9,47078645,,Csf shunt evaluation,A,,0.56,7.90,,7.90,NA,0.08,8.54,8.54,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,16.68,16.68,0.14
9,47178645,26,Csf shunt evaluation,A,,0.56,0.18,,0.18,,0.03,0.77,0.77,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,47278645,TC,Csf shunt evaluation,A,,0.00,7.72,,7.72,NA,0.05,7.77,7.77,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,16.50,16.50,0.11
9,47378650,,Csf leakage imaging,A,,0.59,6.68,,6.68,NA,0.07,7.34,7.34,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,39.35,39.35,0.37
9,47478650,26,Csf leakage imaging,A,,0.59,0.11,,0.11,,0.01,0.71,0.71,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,47578650,TC,Csf leakage imaging,A,,0.00,6.57,,6.57,NA,0.06,6.63,6.63,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,39.24,39.24,0.36
9,47678660,,Nuclear exam of tear flow,A,,0.52,3.40,,3.40,NA,0.05,3.97,3.97,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,12.17,12.17,0.16
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985