Summary & Overview
CPT 78226: Hepatobiliary Scintigraphy (Hepatobiliary Imaging)
CPT code 78226 represents hepatobiliary scintigraphy, a nuclear medicine imaging exam that traces bile production and flow to evaluate bile duct obstruction or leakage, bile duct abnormalities, cholecystitis, gallstones, and other hepatobiliary disorders. This functional imaging study provides dynamic assessment of the liver, bile ducts, and gallbladder and plays a key role in diagnosing surgical and medical hepatobiliary conditions nationwide.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the exam, typical sites of service, and common billing considerations. The publication summarizes national benchmarks for utilization and reimbursement where available, highlights policy updates and coverage trends affecting nuclear hepatobiliary imaging, and outlines relevant clinical indications and coding considerations to support accurate claim submission and payer communication.
This overview is intended for national audiences including payers, health system billing teams, radiology and nuclear medicine departments, and policy analysts seeking a clear summary of the procedure, its clinical utility, and the payer landscape.
Billing Code Overview
CPT code 78226 describes a hepatobiliary scintigraphy exam in which the provider images the liver, bile, bile ducts, and gallbladder to follow the production and flow of bile from the liver to the small intestine. The study is used to diagnose bile duct obstruction or leakage, abnormalities in the bile ducts, cholecystitis (gallbladder inflammation), gallstones, and other disorders affecting the hepatobiliary system.
Service Type: Diagnostic nuclear medicine imaging of the hepatobiliary system
Typical Site of Service: Hospital outpatient imaging departments, radiology or nuclear medicine departments, and freestanding imaging centers
Clinical & Coding Specifications
Clinical Context
A 52-year-old female presents to the outpatient nuclear medicine department with persistent right upper quadrant abdominal pain, intermittent fever, and abnormal liver function tests suggestive of cholestasis. The clinician orders a hepatobiliary scintigraphy to evaluate gallbladder function and to detect acute cholecystitis, cystic duct obstruction, or bile leak following recent laparoscopic cholecystectomy. The patient arrives fasting, intravenous access is obtained, and a radiopharmaceutical (commonly Tc-99m labeled iminodiacetic acid derivative) is administered. Dynamic and delayed planar images are acquired over the liver, biliary tree, gallbladder, and small bowel per the nuclear medicine protocol. If visualization of the gallbladder is delayed or absent, pharmacologic stimulation with morphine or cholecystokinin may be used per protocol. Imaging results are interpreted by the nuclear medicine physician, and a report documenting tracer uptake, biliary excretion, gallbladder visualization, ejection fraction if performed, and any evidence of bile leak or obstruction is generated and routed to the referring surgeon or hepatologist for further management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation/report separate from the technical imaging |