CPT 78801
Global XXX ActiveRp loclzj tum 2+area 1+d img
CPT 78801 Billing & Documentation Guide
CPT code 78801 (Rp loclzj tum 2+area 1+d img) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.71, a non-facility practice expense RVU of 6.4, and a malpractice RVU of 0.08, a total non-facility RVU of 7.19 and facility RVU of 7.19. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $249.58, though rates vary from $208.72 to $336.01 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 78801, 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 78801 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 78801 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 78801
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.71 | 0.71 |
| Practice Expense RVU | 6.4 | 6.4 |
| Malpractice RVU | 0.08 | 0.08 |
| Total RVU | 7.19 | 7.19 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 78801
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 | $278.96 | $278.96 | $259.84 - $336.01 | 29 |
| Florida | $243.39 | $243.39 | $232.09 - $253 | 3 |
| Georgia | $230.88 | $230.88 | $217.58 - $244.18 | 2 |
| Illinois | $235.45 | $235.45 | $223.06 - $248.15 | 4 |
| Michigan | $228.2 | $228.2 | $221.9 - $234.5 | 2 |
| North Carolina | $224.87 | $224.87 | $224.87 - $224.87 | 1 |
| New York | $266.95 | $266.95 | $228.67 - $284.36 | 5 |
| Ohio | $221.58 | $221.58 | $221.58 - $221.58 | 1 |
| Pennsylvania | $236.17 | $236.17 | $222.48 - $249.86 | 2 |
| Texas | $236.78 | $236.78 | $220.72 - $252.29 | 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 78801
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 78801 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 |
| 36011 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36406 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
Frequently Asked Questions, CPT 78801
What does CPT code 78801 mean? +
CPT code 78801 represents: Rp loclzj tum 2+area 1+d img. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 78801? +
The 2026 Medicare national average non-facility payment for CPT 78801 is $249.58. Rates range from $208.72 to $336.01 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 78801? +
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 78801? +
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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