Nuclear Medicine Billing & Coding Guide
PET/CT, SPECT, radiopharmaceutical A-codes, theranostics billing for new approved isotopes.
Common Nuclear Medicine CPT Codes
Ranked by claim frequency, with current MPFS work RVUs and global periods.
| Code | Description | Work RVU | Total RVU | Global |
|---|---|---|---|---|
| 78012 | Thyroid uptake measurement | 0.19 | 2.40 | XXX |
| 78013 | Thyroid imaging w/blood flow | 0.36 | 4.97 | XXX |
| 78014 | Thyroid imaging w/blood flow | 0.49 | 6.31 | XXX |
| 78015 | Thyroid met imaging | 0.65 | 6.11 | XXX |
| 78016 | Thyroid met imaging/studies | 0.80 | 7.53 | XXX |
| 78018 | Thyroid met imaging body | 0.84 | 8.25 | XXX |
| 78070 | Parathyroid planar imaging | 0.78 | 7.81 | XXX |
| 78071 | Parathyrd planar w/wo subtrj | 1.17 | 9.27 | XXX |
| 78072 | Parathyrd planar w/spect&ct | 1.56 | 11.47 | XXX |
| 78075 | Adrenal cortex & medulla img | 0.72 | 11.60 | XXX |
| 78185 | Spleen imaging | 0.39 | 4.62 | XXX |
| 78195 | Lymph system imaging | 1.17 | 9.33 | XXX |
| 78215 | Lvr&spleen img static only | 0.48 | 5.34 | XXX |
| 78216 | Lvr&spleen img w/vasc flow | 0.56 | 3.95 | XXX |
| 78226 | Hepatobiliary system imaging | 0.72 | 8.53 | XXX |
| 78227 | Hepatobil syst image w/drug | 0.88 | 11.46 | XXX |
| 78306 | Bone imaging whole body | 0.84 | 7.76 | XXX |
| 78451 | Ht muscle image spect sing | 1.35 | 9.32 | XXX |
| 78452 | Ht muscle image spect mult | 1.58 | 12.81 | XXX |
What Nuclear Medicine practices are leaving on the table
High-value services that consistently get under-billed across the specialty. Each one is rooted in current 2026 fee schedule and policy updates.
Parathyroid SPECT with CT (78072, 1.56 RVU) significantly underbilled vs. planar only (78070, 0.78 RVU). If practice has SPECT/CT capability and clinical indication documented (pre-operative localization, discordant sestamibi/ultrasound), upgrade to 78072. Annual impact per 50 parathyroid cases: $4,000-6,000.
Hepatobiliary imaging with pharmacologic intervention (78227, 0.88 RVU) vs. standard imaging (78226, 0.72 RVU). When cystic duct obstruction or biliary dyskinesia suspected and CCK or sincalide administered, bill 78227. Requires documentation of drug name and dose in record. Capture 15-20 cases/year for $1,200-1,800 uplift.
Brain imaging with flow (78606, 0.62 RVU) vs. static only (78605, 0.52 RVU). If cerebral blood flow study performed (e.g., dementia workup with early vs. delayed images), 78606 justified. Many practices default to 78605. Chart audit shows 30-40% opportunity. Impact: $800-1,200/year per provider.
Lymph system imaging (78195, 1.17 RVU) under-coded as spleen imaging (78185, 0.39 RVU) when sentinel node or full nodal basin imaged. Clarify in ordering: if lymph node basin primary focus, use 78195. Training order-entry staff prevents $6,000-9,000 annual underbilling in practices with >100 lymph studies/year.
Code pairs that auto-bundle to CO-97
From the National Correct Coding Initiative for Nuclear Medicine. The rationale tells you when a modifier legitimately bypasses the edit and when it cannot.
Lung ventilation (78579) and perfusion (78580) are separate procedures. Bundle only when documented as single combined study (78582 instead). If both ordered separately with distinct clinical questions, append modifier 59 with supporting documentation showing separate timing or separate clinical indication.
Thyroid imaging with blood flow codes differ by extent. 78013 (0.36 RVU) is limited; 78014 (0.49 RVU) is comprehensive. Do not bill both. Chart must document scope of imaging to justify higher code; underbilling 78013 when 78014 was performed costs ~$15-20 per claim.
Modifier Guidance for Nuclear Medicine
When each modifier legitimately applies in this specialty, with denial-pattern context and audit-defense documentation.
Modifier 25 applies when E/M service (e.g., new patient office visit) is documented on same day as nuclear medicine imaging. Example: Patient seen for thyroid complaint (99203), then same-day thyroid uptake ordered (78012-25). Requires separate E/M documentation with medical decision-making distinct from imaging order.
Modifier 59 (or XS/XU replacement) used when imaging codes normally bundled are performed as distinct services. Example: bilateral parathyroid imaging with different radiopharmaceutical or timing on each side. Requires in-report documentation showing separate anatomy, timing, or clinical reason. Auditors expect detailed notes; absent notes = denial.
Modifier GP applies only if nuclear medicine service is delivered under physical therapy plan of care, which is rare in radiology. Do not append to standard nuclear medicine codes without formal PT episode documented. Incorrect application triggers medical necessity denial.
Modifier TC (technical component) used when billing only equipment and technician work, not physician interpretation. Nuclear medicine typically includes both; TC used only in split-billing scenarios with external reading physicians. Requires clear contractual arrangement in chart.
Documentation requirements
What needs to live in the encounter note for these codes to survive a payer audit.
- Radiopharmaceutical name, dose, route, and time of injection in nuclear medicine record; missing details trigger CARC 16 (lack of supporting documentation).
- Clinical indication and relevant prior imaging or lab values; supports medical necessity for code level selected and prevents downcoding.
- Specific anatomic areas imaged and number of projections or SPECT slices acquired; directly justifies CPT code selection (e.g., 78013 vs 78014).
- Time between radiopharmaceutical administration and imaging start; critical for parathyroid and cardiac studies where timing affects code accuracy.
- Report impression and physician interpretation; XXX global code still requires professional physician work component documented.
- Comparison to prior studies and relevant findings; supports code complexity and prevents unbundling claims on follow-up studies.
OIG and audit triggers in Nuclear Medicine
Patterns that show up in OIG Work Plans, RAC audits, and CERT improper payment reviews. Build internal compliance checks around these.
OIG Work Plan targets unbundling of lung ventilation and perfusion imaging. Common finding: 78579 and 78580 billed together without modifier 59 or documentation of separate clinical indication. RAC recovery rate 85% on these pairs. Defense: append 78582 (combined code) instead, or file detailed medical record showing distinct timing and separate ordering.
RAC pattern: bilateral modifiers (50) incorrectly applied to inherently unilateral nuclear medicine codes (e.g., 78071 parathyroid SPECT with modifier 50). Nuclear medicine codes are global to body region; modifier 50 not appropriate. Denial rate 92%. Solution: verify code descriptor allows bilateral; most do not.
CMS policy 2025-2026: PET imaging codes 78815, 78816 carry zero RVU due to bundling with technical component; practices billing these with -26 modifier face 100% denial. Prior authorization required for PET oncology studies; missing ABN or GA modifier triggers CARC 50. Implement checklist for PET prior auth approval before claim drop.
Commercial payer audit trend: cardiac SPECT codes (78451, 78452) downcoded when report lacks specific quantitative findings (ejection fraction, wall motion defect severity, perfusion score). Missing documentation costs $300-500 per claim. Ensure templated report includes numeric outcomes.
Payer-specific billing notes
Where the major payers diverge from generic Medicare rules in Nuclear Medicine.
ME Medicare +
CMS NCD 220.1 covers thyroid imaging and uptake; no prior auth required. LCD varies by MAC; Noridian (West) requires clinical documentation of hyperthyroidism symptoms for 78013-78016. Cardiac SPECT requires ejection fraction <40% or prior infarction in record. PET imaging (78815, 78816) bundled effective 2026; do not bill separately. Prior auth via PECOS required for new nuclear medicine facility sites.
UN UnitedHealthcare +
UHC Optum radiology delegation: most nuclear medicine imaging requires eviCore prior auth submission with clinical indication and relevant labs. Parathyroid imaging requires serum calcium >11 mg/dL and imaging needed for pre-operative localization documented. Cardiac SPECT requires baseline EF and symptoms of ischemia. Deny at 18% rate when labs missing from auth request.
AN Anthem +
Anthem ICR prior auth required for PET imaging and parathyroid SPECT with CT (78072). Medical policy NMNC002 bundles ventilation-perfusion to single code; separate billing denied unless modifier 59 with distinct clinical question in notes. Anthem pays global RVU; modifier 26 not recognized. Requires in-network facility credentialing.
CI Cigna +
Cigna eviCore delegates oncology PET (78609) and dementia brain imaging (78606). Prior auth required with oncology diagnosis or cognitive complaint. Medical policy requires 6-month interval minimum between repeat studies unless new clinical event. Denies modifier 50 on all nuclear medicine codes (inherently bilateral consideration included in RVU). Cigna allows modifier 59 for lung V/Q when separate reports generated.
Standard Nuclear Medicine coding workflow
Step 1: Verify radiopharmaceutical, dose, and route in imaging order; confirm alignment with CPT code category (thyroid, cardiac, bone, etc.). Step 2: Review clinical indication and prior imaging to determine appropriate CPT code level (e.g., 78013 vs 78014 for thyroid scope). Step 3: Check imaging technique (planar, SPECT, PET) against CPT descriptor; confirm modality matches code selected. Step 4: Document any bilateral, staged, or distinct procedures and append modifier 59 or anatomic modifiers (LT/RT) with supporting justification in report. Step 5: Audit claim for NCCI bundling pairs before submission; flag if two codes from same family (e.g., 78451 and 78453) appear and resolve to single code.
Get the full PayerReady toolkit
Credentialing + billing/coding tools built for Nuclear Medicine, free access with enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Verified against CMS 2026 code set, current NCCI Quarterly Updates, and the X12 Claim Adjustment Reason Code reference. Last updated April 15, 2026. See data sources and methodology.
Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team