CPT 78803
Global XXX ActiveRp loclzj tum spect 1 area
CPT 78803 Billing & Documentation Guide
CPT code 78803 (Rp loclzj tum spect 1 area) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.06, a non-facility practice expense RVU of 8.89, and a malpractice RVU of 0.1, a total non-facility RVU of 10.05 and facility RVU of 10.05. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $348.88, though rates vary from $292.19 to $469.27 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 78803, 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 78803 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 78803 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 78803
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.06 | 1.06 |
| Practice Expense RVU | 8.89 | 8.89 |
| Malpractice RVU | 0.1 | 0.1 |
| Total RVU | 10.05 | 10.05 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 78803
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 | $389.84 | $389.84 | $363.24 - $469.27 | 29 |
| Florida | $339.83 | $339.83 | $324.29 - $352.96 | 3 |
| Georgia | $322.73 | $322.73 | $304.25 - $341.21 | 2 |
| Illinois | $328.83 | $328.83 | $311.73 - $346.52 | 4 |
| Michigan | $318.93 | $318.93 | $310.28 - $327.58 | 2 |
| North Carolina | $314.58 | $314.58 | $314.58 - $314.58 | 1 |
| New York | $372.88 | $372.88 | $319.84 - $396.93 | 5 |
| Ohio | $309.87 | $309.87 | $309.87 - $309.87 | 1 |
| Pennsylvania | $330.15 | $330.15 | $311.15 - $349.14 | 2 |
| Texas | $331.04 | $331.04 | $308.72 - $352.59 | 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 78803
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 78803 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01922 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 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 |
Frequently Asked Questions, CPT 78803
What does CPT code 78803 mean? +
CPT code 78803 represents: Rp loclzj tum spect 1 area. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 78803? +
The 2026 Medicare national average non-facility payment for CPT 78803 is $348.88. Rates range from $292.19 to $469.27 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 78803? +
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 78803? +
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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