CPT 78597
Global XXX ActiveLung perfusion differential
CPT 78597 Billing & Documentation Guide
CPT code 78597 (Lung perfusion differential) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.73, a non-facility practice expense RVU of 4.6, and a malpractice RVU of 0.06, a total non-facility RVU of 5.39 and facility RVU of 5.39. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $186.95, though rates vary from $157.4 to $249.69 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 78597, 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 78597 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 78597 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 78597
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.73 | 0.73 |
| Practice Expense RVU | 4.6 | 4.6 |
| Malpractice RVU | 0.06 | 0.06 |
| Total RVU | 5.39 | 5.39 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 78597
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 | $208.15 | $208.15 | $194.27 - $249.69 | 29 |
| Florida | $182.44 | $182.44 | $174.28 - $189.39 | 3 |
| Georgia | $173.39 | $173.39 | $163.82 - $182.97 | 2 |
| Illinois | $176.76 | $176.76 | $167.79 - $185.9 | 4 |
| Michigan | $171.48 | $171.48 | $166.92 - $176.03 | 2 |
| North Carolina | $169.01 | $169.01 | $169.01 - $169.01 | 1 |
| New York | $199.67 | $199.67 | $171.75 - $212.35 | 5 |
| Ohio | $166.68 | $166.68 | $166.68 - $166.68 | 1 |
| Pennsylvania | $177.24 | $177.24 | $167.32 - $187.16 | 2 |
| Texas | $177.64 | $177.64 | $166.06 - $188.76 | 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 78597
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 78597 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 78597
What does CPT code 78597 mean? +
CPT code 78597 represents: Lung perfusion differential. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 78597? +
The 2026 Medicare national average non-facility payment for CPT 78597 is $186.95. Rates range from $157.4 to $249.69 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 78597? +
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 78597? +
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 June 1, 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