CPT 78609
Global XXXBrain imaging (pet)
CPT 78609 Billing & Documentation Guide
CPT code 78609 (Brain imaging (pet)) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.46, a non-facility practice expense RVU of 0.64, and a malpractice RVU of 0.04, a total non-facility RVU of 2.14 and facility RVU of 2.14. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $73.22, though rates vary from $67.82 to $96.65 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 78609, 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 78609 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Non-covered service
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 0 units of 78609 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 78609
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.46 | 1.46 |
| Practice Expense RVU | 0.64 | 0.64 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 2.14 | 2.14 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 78609
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 | $76.53 | $76.53 | $73.74 - $85.67 | 29 |
| Florida | $72.82 | $72.82 | $71.21 - $74.4 | 3 |
| Georgia | $70.83 | $70.83 | $69.43 - $72.23 | 2 |
| Illinois | $72.15 | $72.15 | $70.37 - $73.66 | 4 |
| Michigan | $70.72 | $70.72 | $69.79 - $71.65 | 2 |
| North Carolina | $69.56 | $69.56 | $69.56 - $69.56 | 1 |
| New York | $76.74 | $76.74 | $70.01 - $79.78 | 5 |
| Ohio | $69.63 | $69.63 | $69.63 - $69.63 | 1 |
| Pennsylvania | $71.57 | $71.57 | $69.65 - $73.49 | 2 |
| Texas | $71.32 | $71.32 | $69.46 - $72.66 | 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 78609
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 78609 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36000 | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
| 36005 | Column 1 (primary), can be billed with modifier | 9 | Misuse of Column Two code with Column One code |
| 36410 | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
| 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 |
| 76375 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 76376 | Column 1 (primary), can be billed with modifier | 9 | CPT Manual or CMS manual coding instruction |
| 76377 | Column 1 (primary), can be billed with modifier | 9 | CPT Manual or CMS manual coding instruction |
| 90760 | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
| 90765 | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 78609
What does CPT code 78609 mean? +
CPT code 78609 represents: Brain imaging (pet). It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 78609? +
The 2026 Medicare national average non-facility payment for CPT 78609 is $73.22. Rates range from $67.82 to $96.65 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 78609? +
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 78609? +
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 June 1, 2026.
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