Summary & Overview
CPT 78835: Quantitative Radiopharmaceutical Measurement, Single Area
CPT code 78835 designates an add-on service reported alongside an appropriate primary code when the clinician quantifies the amount of a radiopharmaceutical agent within a single anatomical area rather than only describing its distribution. Nationally, this supplemental code supports documentation and billing for quantitative nuclear medicine measurements that can influence clinical interpretation, therapy planning, and follow-up assessments. Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what the code represents, typical clinical and site-of-service contexts, and which payers are relevant to coverage and reimbursement discussions. The publication provides benchmarks and policy-relevant considerations for billing this add-on measurement service, clarifies typical use cases in nuclear medicine imaging workflows, and highlights documentation elements associated with quantitative radiopharmaceutical reporting. Data not provided in the input (such as specific coverage policies, associated taxonomies, ICD-10 diagnoses, and related codes) are noted as unavailable where applicable.
Billing Code Overview
CPT code 78835 is reported in addition to an appropriate primary code when the provider quantifies the amount (rather than merely assessing the distribution) of a radiopharmaceutical agent in a single area. This code captures a supplemental measurement service that provides a quantified activity or uptake value for a defined anatomical region.
Service Type
- Quantitative radiopharmaceutical measurement
Typical Site of Service
- Nuclear medicine departments, hospital outpatient imaging centers, or other imaging facilities where radiopharmaceuticals are administered and measured
Clinical & Coding Specifications
Clinical Context
A patient with suspected focal uptake of a radiopharmaceutical (for example, a patient undergoing targeted radiopharmaceutical therapy planning or focal diagnostic localization) presents to nuclear medicine for imaging and quantification of radiotracer activity in a single anatomic area. The patient is typically referred by an oncologist or nuclear medicine physician after prior diagnostic imaging (CT, MRI, or PET) identifies a region of interest. In the clinical workflow, an appropriate primary nuclear medicine or imaging study (such as a whole-body or regional scintigraphy, SPECT, or PET scan) is performed first; when the interpreting provider performs additional measurement to quantify the amount of radiopharmaceutical localized to a single site (for example, calculating absolute activity in millicuries at a tumor site or transplant organ), the add-on code 78835 is reported in addition to the primary imaging code. Typical sites of service include hospital outpatient imaging centers, freestanding imaging centers, and inpatient nuclear medicine departments. The typical patient scenario includes: a middle-aged oncology patient referred for quantification of radiotracer uptake in a solitary metastatic lesion to assess eligibility for radionuclide therapy; the nuclear medicine physician documents the quantitative measurement method, the measured activity in the single area, and includes the quantification result in the report for treatment planning or dosimetry.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |