CPT 78216
Global XXX ActiveLvr&spleen img w/vasc flow
CPT 78216 Billing & Documentation Guide
CPT code 78216 (Lvr&spleen img w/vasc flow) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.56, a non-facility practice expense RVU of 3.32, and a malpractice RVU of 0.07, a total non-facility RVU of 3.95 and facility RVU of 3.95. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $136.82, though rates vary from $115.16 to $181.92 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 78216, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 78216 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 78216 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 78216
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.56 | 0.56 |
| Practice Expense RVU | 3.32 | 3.32 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 3.95 | 3.95 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 78216
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $151.86 | $151.86 | $141.81 - $181.92 | 29 |
| Florida | $134.51 | $134.51 | $128.23 - $140.05 | 3 |
| Georgia | $127.32 | $127.32 | $120.41 - $134.23 | 2 |
| Illinois | $130.39 | $130.39 | $123.6 - $136.86 | 4 |
| Michigan | $126.13 | $126.13 | $122.59 - $129.66 | 2 |
| North Carolina | $123.66 | $123.66 | $123.66 - $123.66 | 1 |
| New York | $146.48 | $146.48 | $125.69 - $156.09 | 5 |
| Ohio | $122.3 | $122.3 | $122.3 - $122.3 | 1 |
| Pennsylvania | $129.99 | $129.99 | $122.71 - $137.27 | 2 |
| Texas | $130.15 | $130.15 | $121.79 - $138.14 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 78216
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 78216 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0394T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0395T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0694T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36005 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 78216
What does CPT code 78216 mean? +
CPT code 78216 represents: Lvr&spleen img w/vasc flow. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 78216? +
The 2026 Medicare national average non-facility payment for CPT 78216 is $136.82. Rates range from $115.16 to $181.92 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 78216? +
Radiology codes rely heavily on the professional/technical split: modifier 26 (professional component only) and TC (technical component only). Also common: 50 (bilateral imaging), 76 (repeat by same physician), 77 (repeat by different physician), and LT/RT for laterality.
What bundling edits apply to CPT 78216? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team