CPT 78606
Global XXX ActiveBrain image w/flow 4 + views
CPT 78606 Billing & Documentation Guide
CPT code 78606 (Brain image w/flow 4 + views) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.62, a non-facility practice expense RVU of 7.92, and a malpractice RVU of 0.08, a total non-facility RVU of 8.62 and facility RVU of 8.62. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $299.5, though rates vary from $249.32 to $405.88 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 78606, 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 78606 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 78606 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 78606
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.62 | 0.62 |
| Practice Expense RVU | 7.92 | 7.92 |
| Malpractice RVU | 0.08 | 0.08 |
| Total RVU | 8.62 | 8.62 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 78606
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 | $335.92 | $335.92 | $312.42 - $405.88 | 29 |
| Florida | $291.33 | $291.33 | $277.62 - $302.85 | 3 |
| Georgia | $276.31 | $276.31 | $259.86 - $292.75 | 2 |
| Illinois | $281.5 | $281.5 | $266.41 - $297.27 | 4 |
| Michigan | $272.87 | $272.87 | $265.25 - $280.49 | 2 |
| North Carolina | $269.23 | $269.23 | $269.23 - $269.23 | 1 |
| New York | $320.44 | $320.44 | $273.9 - $341.53 | 5 |
| Ohio | $264.92 | $264.92 | $264.92 - $264.92 | 1 |
| Pennsylvania | $282.87 | $282.87 | $266.08 - $299.65 | 2 |
| Texas | $283.74 | $283.74 | $263.92 - $303 | 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 78606
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 78606 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 78606
What does CPT code 78606 mean? +
CPT code 78606 represents: Brain image w/flow 4 + views. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 78606? +
The 2026 Medicare national average non-facility payment for CPT 78606 is $299.5. Rates range from $249.32 to $405.88 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 78606? +
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 78606? +
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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