CPT 78605
Global XXX ActiveBrain image 4+ views
CPT 78605 Billing & Documentation Guide
CPT code 78605 (Brain image 4+ views) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.52, a non-facility practice expense RVU of 4.78, and a malpractice RVU of 0.07, a total non-facility RVU of 5.37 and facility RVU of 5.37. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $186.35, though rates vary from $155.72 to $250.76 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 78605, 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 78605 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 78605 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 78605
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.52 | 0.52 |
| Practice Expense RVU | 4.78 | 4.78 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 5.37 | 5.37 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 78605
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 | $208.18 | $208.18 | $193.9 - $250.76 | 29 |
| Florida | $182.11 | $182.11 | $173.51 - $189.48 | 3 |
| Georgia | $172.51 | $172.51 | $162.57 - $182.44 | 2 |
| Illinois | $176.17 | $176.17 | $166.79 - $185.6 | 4 |
| Michigan | $170.58 | $170.58 | $165.77 - $175.38 | 2 |
| North Carolina | $167.82 | $167.82 | $167.82 - $167.82 | 1 |
| New York | $199.48 | $199.48 | $170.69 - $212.65 | 5 |
| Ohio | $165.49 | $165.49 | $165.49 - $165.49 | 1 |
| Pennsylvania | $176.4 | $176.4 | $166.14 - $186.67 | 2 |
| Texas | $176.82 | $176.82 | $164.83 - $188.39 | 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 78605
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 78605 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 78605
What does CPT code 78605 mean? +
CPT code 78605 represents: Brain image 4+ views. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 78605? +
The 2026 Medicare national average non-facility payment for CPT 78605 is $186.35. Rates range from $155.72 to $250.76 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 78605? +
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 78605? +
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 April 17, 2026.
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