Summary & Overview
CPT 78264: Hepatobiliary Imaging with Pharmacologic Intervention
CPT code 78264 represents hepatobiliary system imaging with pharmacologic intervention, a specialized radiology procedure used to assess the liver, gallbladder, and biliary tract. This code is significant nationally due to its role in diagnosing and managing complex hepatobiliary disorders, including gallbladder disease and abnormal liver function. The procedure is typically performed in outpatient hospital settings and involves the use of agents like cholecystokinin or morphine to enhance diagnostic accuracy.
Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, clinical indications, and relevant billing practices for this code. Readers will gain insights into current benchmarks, policy updates, and the clinical context surrounding hepatobiliary imaging with pharmacologic intervention. The summary also highlights associated modifiers, taxonomies, and ICD-10 diagnoses commonly linked to this procedure, offering a clear understanding of its place in radiology and hepatology practice. This information is essential for stakeholders seeking to navigate reimbursement, compliance, and clinical utilization trends for CPT code 78264.
CPT Code Overview
CPT code 78264 is used for imaging the hepatobiliary system, including the gallbladder when present, with pharmacologic intervention such as cholecystokinin or morphine. This procedure may include quantitative measurements when performed. It falls under the Radiology service type and is typically conducted in an Outpatient Hospital setting (Place of Service 22). The imaging assists in evaluating the function and structure of the liver, gallbladder, and biliary tract, providing critical diagnostic information for a range of hepatobiliary conditions.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to the outpatient hospital with persistent right upper quadrant abdominal pain. The clinician suspects a biliary disorder, such as gallbladder dysfunction or cholecystitis, and orders hepatobiliary system imaging with pharmacologic intervention. The procedure uses nuclear medicine techniques to assess gallbladder function, often employing agents like cholecystokinin or morphine to stimulate or inhibit biliary activity. Quantitative measurements may be performed to evaluate gallbladder ejection fraction or biliary drainage. The workflow includes radiology staff preparing the patient, administering the radiotracer and pharmacologic agent, acquiring images, and interpreting results to guide further management.
Coding Specifications
-
Modifier
26: Used when reporting only the professional component of the imaging service (interpretation and report by the physician). -
Modifier
TC: Used when reporting only the technical component (equipment, supplies, and technical staff). -
Associated Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
2085R0202X | Radiology, Nuclear Radiology |
207RI0008X | Internal Medicine, Hepatology |
207RG0100X | Gastroenterology Physician |
These taxonomies represent providers specializing in nuclear radiology, hepatology, and gastroenterology, all of whom may be involved in ordering or interpreting hepatobiliary imaging.
Related Diagnoses
-
K80.20: Calculus of gallbladder without cholecystitis- Relevant for patients with gallstones but no evidence of inflammation, often requiring functional imaging to assess biliary obstruction.
-
K81.9: Cholecystitis, unspecified- Used when gallbladder inflammation is suspected but not specifically classified, supporting the need for imaging to confirm diagnosis.
-
K82.9: Disease of gallbladder, unspecified- Applies to patients with non-specific gallbladder disease, where imaging helps clarify the underlying condition.
-
R93.2: Abnormal findings on diagnostic imaging of liver and biliary tract- Indicates prior imaging has revealed abnormalities, prompting further hepatobiliary imaging for detailed assessment.
-
R10.11: Right upper quadrant pain- Common presenting symptom for biliary disorders, justifying the use of hepatobiliary imaging to investigate the cause.
Related CPT Codes
-
78223: Hepatobiliary system imaging, including gallbladder when present- Used for standard hepatobiliary imaging without pharmacologic intervention. May be performed prior to or instead of
78264if functional assessment is not required.
- Used for standard hepatobiliary imaging without pharmacologic intervention. May be performed prior to or instead of
-
78227: Hepatobiliary system imaging with pharmacologic intervention- Similar to
78264, but may differ in scope or quantitative measurements. Often used as an alternative or in conjunction with78264depending on clinical needs.
- Similar to
-
78278: Liver imaging with vascular flow- Focuses on liver vascular flow assessment. May be used alongside hepatobiliary imaging to evaluate broader hepatic function.
-
78282: Liver imaging with vascular flow and function- Provides comprehensive evaluation of liver vascular flow and function. Can be used in cases where both liver and biliary tract assessment are needed.
Codes 78223 and 78227 are most closely related to 78264 and may be used as alternatives or in sequence, depending on the clinical scenario.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 78264 is $201.98 for Medicare, while the average commercial benchmark (BUCA) is $256.77. Commercial payers such as UnitedHealth Group and Cigna have higher mean rates, with UnitedHealth Group at $318.41 and Cigna at $291.88, compared to Medicare.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Aetna has the tightest range at $65.50, indicating less variability in rates, while Cigna and UnitedHealth Group show the widest dispersions at $184.67 and $156.67, respectively. This suggests that commercial payers may have greater variability in contracted rates than Medicare or Aetna.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.