Billing code 78801: Tumor imagingMedicare rate & RVUs in Utah
Reports one-day radiopharmaceutical tumor-localization imaging covering two or more areas, such as when a nuclear medicine study evaluates multiple suspected tumor sites.
Medicare pays $227.05 for 78801 in the office in Utah (Utah). 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 78801 covers
This nuclear medicine study uses a radioactive tracer to produce images that help locate tumor tissue in two or more areas during one day of imaging. A nuclear medicine technologist typically performs the acquisition in a hospital or imaging center, and a radiologist or nuclear medicine physician interprets the study. The selected code reflects the extent and timing of the imaging, not the number of lesions found.
Document the clinical indication, radiopharmaceutical used, areas imaged, imaging date, and interpretation. Report one service for the two-or-more-area, one-day study; the code is not selected per lesion. It is a diagnostic test with separately identifiable professional and technical components: modifier 26 reports interpretation, modifier TC reports equipment and staff, and no component modifier represents the global service. Radiopharmaceutical injection may be separately represented by 78808 when applicable.
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.
78801 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $227.05 | Unavailable |
How the 78801 rate is calculated
Each of 78801’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 · 78801
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.71Practice expense 6.40Malpractice 0.08
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78801
The CMS indicators that decide how 78801 is paid alongside other services.
CMS payment indicators · 78801
Tumor imaging
| 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
78801 without 26 · national office
$240.15
Tumor imaging
78801-26 · Professional component
$33.07
Pays only the interpretation and report.
78801 compared with similar codes
Compare codes
78801 vs 78800 vs 78802 vs 78804 vs 78831: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 78800Tumor imaging
- Use 78800 for one imaged area during one day; use 78801 when two or more areas are imaged that day.
- 78802Tumor imaging
- 78802 describes whole-body tumor localization with one-day imaging. 78801 describes two or more areas rather than a whole-body study.
- 78804Tumor localization
- 78804 is for whole-body imaging performed over two or more days; 78801 is for two or more areas imaged in one day.
- 78831Tumor SPECT
- 78831 is the SPECT study for two or more areas. Choose 78801 when the study is not reported as SPECT.
78801 billing questions
When should 78801 be selected instead of 78800?
Use 78801 when tumor-localization imaging covers two or more areas in one day. Code 78800 describes one area with one-day imaging.
Does this code include radiopharmaceutical administration?
The imaging code describes the localization study. Code 78808 represents injection for a diagnostic radiopharmaceutical study and may be reported with it when applicable.
How are the professional and technical services billed?
Use modifier 26 for the interpretation and report, or modifier TC for the equipment and staff. Report the service without either modifier when billing globally.
What documentation supports reporting two or more areas?
The record should identify the areas imaged, the study date, the radiopharmaceutical, the indication, and the interpreting physician’s findings. It should support imaging of at least two areas during the one-day study.
How does 78801 differ from whole-body imaging?
78801 is for two or more areas imaged in one day. Whole-body studies use the whole-body codes, with 78804 identifying imaging over two or more days.
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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