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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.

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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

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CPT 78226: Hepatobiliary Scintigraphy (Hepatobiliary Imaging)

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Billing Code Overview

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
`52`	Reduced services	Use when the study was started but discontinued or performed in a limited fashion
`53`	Discontinued procedure	Use when the procedure is terminated for patient-related reasons before completion
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure or service unrelated to other services on the same day
`76`	Repeat procedure by same physician	Use when the same study is repeated subsequent to the initial study by the same provider (note: `76` not in provided list; alternative provided modifiers used instead)
`78`	Unplanned return to the operating/procedure room by same physician following initial procedure for a related procedure	Use when a post-procedural complication requires an immediate additional procedure (applicable if imaging is part of perioperative complication workup)
`80`	Assistive personnel (assistant surgeon)	Use when an assistant surgeon is reported (rare for diagnostic imaging; included if intraoperative imaging documented)
`QK`	Medical direction of two or more qualified individuals	Use when physician directed multiple practitioners during service (applicable where medical direction rules apply)
`QX`	Certified nurse-midwife, clinical nurse specialist, nurse practitioner, or physician assistant service	Use when the technical or professional component is furnished by these practitioners per payer policy
`TC`	Technical component	Use when billing only the equipment, technologist, and radiopharmaceutical costs separate from the physician interpretation
`22`	Increased procedural services beyond usual	Use when additional work or time significantly increases the resource use (document justification)
`23`	Unusual anesthesia	Use where unusual anesthesia is required for the imaging (rare for hepatobiliary scans)
`52`	Reduced services	Use when the study is partially completed (duplicate entry for emphasis on applicability)

Taxonomy Code	Specialty	Notes
`2085R0200X`	Diagnostic Radiology	Nuclear medicine and diagnostic imaging specialists who interpret hepatobiliary scintigraphy
`2084P0800X`	Nuclear Medicine	Physicians specialized in nuclear medicine who perform and interpret hepatobiliary scans
`207RC0000X`	Gastroenterology	Ordering and clinically managing hepatobiliary disease; may interpret results when credentialed
`207L00000X`	General Surgery	Surgeons managing cholecystectomy patients and post-op bile leak evaluation
`363A00000X`	Physician Assistant	Mid-level providers who may assist or perform portions of the service under supervision

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K81.0`	Acute cholecystitis	Common indication for hepatobiliary scintigraphy when ultrasound is equivocal; absence of gallbladder visualization suggests acute cholecystitis
`K80.10`	Calculus of gallbladder without cholecystitis	Evaluation of biliary colic and functional obstruction related to gallstones
`K83.1`	Obstruction of bile duct	Direct indication for hepatobiliary imaging to localize and assess level of obstruction
`K82.4`	Bile duct cyst, acquired	Imaging may assist in functional assessment and bile flow in ductal anomalies
`R17`	Unspecified jaundice	Scintigraphy helps determine obstructive versus hepatocellular cause when biochemical cholestasis is present
`T81.4`	Infection following a procedure, not elsewhere classified	Postoperative patients with suspected bile leak or postoperative infection may undergo hepatobiliary scintigraphy to detect leaks
`K83.2`	Bile duct stricture	Used to evaluate functional significance and locate strictures contributing to cholestasis
`R10.11`	Right upper quadrant pain	Symptom-driven indication when biliary causes are suspected

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78226`	Hepatobiliary scintigraphy; imaging of liver, bile, bile ducts, and gallbladder to follow bile production and flow	Primary procedure — used to diagnose bile duct obstruction, bile leak, acute cholecystitis, gallstones, and other hepatobiliary disorders
`78227`	Hepatobiliary scintigraphy with evaluation of gallbladder ejection fraction (CCK stimulation)	Often performed adjunctively when assessment of gallbladder contractility/ejection fraction is clinically indicated during the same imaging session
`78800`	Radiopharmaceutical localization of tumor; simple planar imaging (general nuclear medicine)	Related nuclear medicine imaging code category used for other planar scintigraphic studies; may be used for additional or alternative nuclear studies
`76536`	Ultrasonography, transabdominal, real time with image documentation; limited or focused (e.g., biliary tract)	Commonly performed before or after scintigraphy to evaluate gallbladder wall thickness, stones, or biliary dilation
`47562`	Laparoscopy, surgical, cholecystectomy	Surgical procedure related to management when hepatobiliary scintigraphy demonstrates pathology requiring operative intervention

CPT 78201: Liver and Spleen Scan, Diagnostic Nuclear Medicine

CPT-78202-LIVER-SPLEEN-SCAN-NUCLEAR-MEDICINE

CPT 78202: Liver and Spleen Scan, Nuclear Medicine

CPT-78215-LIVER-SPLEEN-SCAN-NUCLEAR-MEDICINE

CPT 78215: Liver and Spleen Scan, Nuclear Medicine

CPT-78216-LIVER-SPLEEN-SCAN-DIAGNOSTIC-IMAGING

CPT 78216: Liver and Spleen Scan, Diagnostic Imaging

CPT-78227-HEPATOBILIARY-SCINTIGRAPHY-LIVER-BILE-GALLBLADDER-IMAGING

CPT 78227: Hepatobiliary Scintigraphy for Liver-Bile-Gallbladder Imaging

CPT-78230-SALIVARY-GLAND-NUCLEAR-IMAGING

CPT 78230: Salivary Gland Nuclear Imaging, Post-Injection

CPT-78231-SALIVARY-GLAND-NUCLEAR-IMAGING-SERIAL-IMAGES

CPT 78231: Salivary Gland Nuclear Imaging, Serial Post-Injection

CPT-78232-SALIVARY-GLAND-SCINTIGRAPHY-PAROTID-FUNCTION

CPT 78232: Salivary Gland Scintigraphy (Parotid Function)

CPT-78258-ESOPHAGEAL-TRANSIT-SCINTIGRAPHY-ESOPHAGEAL-MOTILITY-STUDY

CPT 78258: Esophageal Transit Scintigraphy for Esophageal Motility

CPT-78261-GASTRIC-MUCOSA-RADIONUCLIDE-IMAGING

CPT 78261: Radionuclide Imaging of Gastric Mucosa

Showing 1–10 of 21

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation/report separate from the technical imaging
`52`	Reduced services	Use when the study was started but discontinued or performed in a limited fashion
`53`	Discontinued procedure	Use when the procedure is terminated for patient-related reasons before completion
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure or service unrelated to other services on the same day
`76`	Repeat procedure by same physician	Use when the same study is repeated subsequent to the initial study by the same provider (note: `76` not in provided list; alternative provided modifiers used instead)
`78`	Unplanned return to the operating/procedure room by same physician following initial procedure for a related procedure	Use when a post-procedural complication requires an immediate additional procedure (applicable if imaging is part of perioperative complication workup)
`80`	Assistive personnel (assistant surgeon)	Use when an assistant surgeon is reported (rare for diagnostic imaging; included if intraoperative imaging documented)
`QK`	Medical direction of two or more qualified individuals	Use when physician directed multiple practitioners during service (applicable where medical direction rules apply)
`QX`	Certified nurse-midwife, clinical nurse specialist, nurse practitioner, or physician assistant service	Use when the technical or professional component is furnished by these practitioners per payer policy
`TC`	Technical component	Use when billing only the equipment, technologist, and radiopharmaceutical costs separate from the physician interpretation
`22`	Increased procedural services beyond usual	Use when additional work or time significantly increases the resource use (document justification)
`23`	Unusual anesthesia	Use where unusual anesthesia is required for the imaging (rare for hepatobiliary scans)
`52`	Reduced services	Use when the study is partially completed (duplicate entry for emphasis on applicability)

Taxonomy Code	Specialty	Notes
`2085R0200X`	Diagnostic Radiology	Nuclear medicine and diagnostic imaging specialists who interpret hepatobiliary scintigraphy
`2084P0800X`	Nuclear Medicine	Physicians specialized in nuclear medicine who perform and interpret hepatobiliary scans
`207RC0000X`	Gastroenterology	Ordering and clinically managing hepatobiliary disease; may interpret results when credentialed
`207L00000X`	General Surgery	Surgeons managing cholecystectomy patients and post-op bile leak evaluation
`363A00000X`	Physician Assistant	Mid-level providers who may assist or perform portions of the service under supervision

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K81.0`	Acute cholecystitis	Common indication for hepatobiliary scintigraphy when ultrasound is equivocal; absence of gallbladder visualization suggests acute cholecystitis
`K80.10`	Calculus of gallbladder without cholecystitis	Evaluation of biliary colic and functional obstruction related to gallstones
`K83.1`	Obstruction of bile duct	Direct indication for hepatobiliary imaging to localize and assess level of obstruction
`K82.4`	Bile duct cyst, acquired	Imaging may assist in functional assessment and bile flow in ductal anomalies
`R17`	Unspecified jaundice	Scintigraphy helps determine obstructive versus hepatocellular cause when biochemical cholestasis is present
`T81.4`	Infection following a procedure, not elsewhere classified	Postoperative patients with suspected bile leak or postoperative infection may undergo hepatobiliary scintigraphy to detect leaks
`K83.2`	Bile duct stricture	Used to evaluate functional significance and locate strictures contributing to cholestasis
`R10.11`	Right upper quadrant pain	Symptom-driven indication when biliary causes are suspected

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78226`	Hepatobiliary scintigraphy; imaging of liver, bile, bile ducts, and gallbladder to follow bile production and flow	Primary procedure — used to diagnose bile duct obstruction, bile leak, acute cholecystitis, gallstones, and other hepatobiliary disorders
`78227`	Hepatobiliary scintigraphy with evaluation of gallbladder ejection fraction (CCK stimulation)	Often performed adjunctively when assessment of gallbladder contractility/ejection fraction is clinically indicated during the same imaging session
`78800`	Radiopharmaceutical localization of tumor; simple planar imaging (general nuclear medicine)	Related nuclear medicine imaging code category used for other planar scintigraphic studies; may be used for additional or alternative nuclear studies
`76536`	Ultrasonography, transabdominal, real time with image documentation; limited or focused (e.g., biliary tract)	Commonly performed before or after scintigraphy to evaluate gallbladder wall thickness, stones, or biliary dilation
`47562`	Laparoscopy, surgical, cholecystectomy	Surgical procedure related to management when hepatobiliary scintigraphy demonstrates pathology requiring operative intervention

CPT 78201: Liver and Spleen Scan, Diagnostic Nuclear Medicine

CPT-78202-LIVER-SPLEEN-SCAN-NUCLEAR-MEDICINE

CPT 78202: Liver and Spleen Scan, Nuclear Medicine

CPT-78215-LIVER-SPLEEN-SCAN-NUCLEAR-MEDICINE

CPT 78215: Liver and Spleen Scan, Nuclear Medicine

CPT-78216-LIVER-SPLEEN-SCAN-DIAGNOSTIC-IMAGING

CPT 78216: Liver and Spleen Scan, Diagnostic Imaging

CPT-78227-HEPATOBILIARY-SCINTIGRAPHY-LIVER-BILE-GALLBLADDER-IMAGING

CPT 78227: Hepatobiliary Scintigraphy for Liver-Bile-Gallbladder Imaging

CPT-78230-SALIVARY-GLAND-NUCLEAR-IMAGING

CPT 78230: Salivary Gland Nuclear Imaging, Post-Injection

CPT-78231-SALIVARY-GLAND-NUCLEAR-IMAGING-SERIAL-IMAGES

CPT 78231: Salivary Gland Nuclear Imaging, Serial Post-Injection

CPT-78232-SALIVARY-GLAND-SCINTIGRAPHY-PAROTID-FUNCTION

CPT 78232: Salivary Gland Scintigraphy (Parotid Function)

CPT-78258-ESOPHAGEAL-TRANSIT-SCINTIGRAPHY-ESOPHAGEAL-MOTILITY-STUDY

CPT 78258: Esophageal Transit Scintigraphy for Esophageal Motility

CPT-78261-GASTRIC-MUCOSA-RADIONUCLIDE-IMAGING

CPT 78261: Radionuclide Imaging of Gastric Mucosa

Showing 1–10 of 21

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 78226: Hepatobiliary Scintigraphy (Hepatobiliary Imaging)

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Billing Code Overview

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CPT 78226: Hepatobiliary Scintigraphy (Hepatobiliary Imaging)

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 78226: Hepatobiliary Scintigraphy (Hepatobiliary Imaging)

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Billing Code Overview

CPT 78226: Hepatobiliary Scintigraphy (Hepatobiliary Imaging)

Sign up for cpt 78226 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical purpose does CPT 78226 serve and where is it typically performed?

Which billing modifiers are applicable to CPT 78226 and when are they used?

How does CPT 78226 relate to other CPT codes such as 78227 and 76536?

What diagnoses commonly justify ordering a hepatobiliary scintigraphy (CPT 78226)?

Which payers and reimbursement information are referenced for CPT 78226?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical purpose does CPT 78226 serve and where is it typically performed?

Which billing modifiers are applicable to CPT 78226 and when are they used?

How does CPT 78226 relate to other CPT codes such as 78227 and 76536?

What diagnoses commonly justify ordering a hepatobiliary scintigraphy (CPT 78226)?

Which payers and reimbursement information are referenced for CPT 78226?

References