CPT 78226
Global XXX ActiveHepatobiliary system imaging
CPT 78226 Billing & Documentation Guide
CPT code 78226 (Hepatobiliary system imaging) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.72, a non-facility practice expense RVU of 7.72, and a malpractice RVU of 0.09, a total non-facility RVU of 8.53 and facility RVU of 8.53. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $296.22, though rates vary from $247.09 to $400.13 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 78226, 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 78226 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 78226 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 78226
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.72 | 0.72 |
| Practice Expense RVU | 7.72 | 7.72 |
| Malpractice RVU | 0.09 | 0.09 |
| Total RVU | 8.53 | 8.53 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 78226
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 | $331.65 | $331.65 | $308.68 - $400.13 | 29 |
| Florida | $288.62 | $288.62 | $275.08 - $300.08 | 3 |
| Georgia | $273.67 | $273.67 | $257.64 - $289.71 | 2 |
| Illinois | $279.03 | $279.03 | $264.17 - $294.36 | 4 |
| Michigan | $270.41 | $270.41 | $262.86 - $277.95 | 2 |
| North Carolina | $266.55 | $266.55 | $266.55 - $266.55 | 1 |
| New York | $316.94 | $316.94 | $271.12 - $337.76 | 5 |
| Ohio | $262.5 | $262.5 | $262.5 - $262.5 | 1 |
| Pennsylvania | $280.05 | $280.05 | $263.6 - $296.49 | 2 |
| Texas | $280.83 | $280.83 | $261.49 - $299.57 | 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 78226
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 78226 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 76000 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 76001 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 78226
What does CPT code 78226 mean? +
CPT code 78226 represents: Hepatobiliary system imaging. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 78226? +
The 2026 Medicare national average non-facility payment for CPT 78226 is $296.22. Rates range from $247.09 to $400.13 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 78226? +
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 78226? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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