HIDA Scan CPT Codes (2022) – Descriptions, Guidelines, Reimbursement, Modifiers & Examples

HIDA scan CPT code(s) are CPT 78226 and CPT 78227. These are used to bill for service when the Physician performs a Hepatobiliary system imaging, comprising gallbladder if present. HIDA performs scans of the bile ducts, including the liver and gall bladder. 

HIDA Scan CPT Code Summary

A HIDA scan detects various reasons such as bile leakage, gall stones, Cholecystitis (an inflamed gallbladder), and congenital bile defects and ensures that the liver is working correctly after transplant.

A scintillation or gamma camera takes images of the bile duct system. It produces light when it reflects with a radio-pharmaceutical substance.

An amino-acetic acid (radio label substance) is administered via the peripheral vein, excreted in the bile duct, and rapidly cleared by hepatocytes. It aids in detecting any blockage in the bile duct or diseases. 

HIDA may perform with or without pharmacologic intervention to visualize the gallbladder and measure its function. It aids in diagnosing such as stones, polyps, and cholesterolosis.

It is absorbed in the intestine after getting concentrated in the gall bladder. Radio substances are administered orally and excreted in the liver. 

CPT 78826 reports that only Heptobillary imagining performs. In contrast, 78227 bills when Heptobillary imagining performs with pharmacological intervention and qualitative measurements.

HIDA Scan CPT Code Description 

CPT 78226 bills for service when the Physician performs Hepatobiliary system imaging, comprising gallbladder if present. 

CPT 78227 bills for service when the Physician performs Hepatobiliary system imaging, comprising gallbladder if present, in conjunction with pharmacologic intervention, including quantitative measurement(s).

HIDA Scan CPT Code Reimbursement

A maximum of one unit can be a bill on the same service date of CPT 78226 and 78227. In contrast, the Three unit allows when documentation supports the medical necessity of the service. 

The cost and RUVS of CPT 78826 with modifier 26 are $38.05 and 1.09955 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 78226 with modifier 26 are $38.05 and 1.09955 when performed in the non-facility.

The cost and RUVS of CPT 78226 with modifier TC are $331.89 and 9.59060 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 78226 with modifier TC are $331.89 and 9.59060 when performed in the non-facility.

The cost and RUVS of CPT 78226 with global billing are $369.95 and 10.69015 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 78226 with global billing are $369.95 and 10.69015 when performed in the non-facility.

The cost and RUVS of CPT 78827 with modifier 26 are $46.29 and 1.33773 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 78227 with modifier 26 are $46.29 and 1.33773 when performed in the non-facility.

The cost and RUVS of CPT 78227 with modifier TC are $451.97 and 13.06024 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 78227 with modifier TC are $451.97 and 13.06024 when performed in the non-facility.

The cost and RUVS of CPT 78826 with global billing are $498.26 and 14.39797 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 78227 with global billing are $498.26 and 14.39797 when performed in the non-facility.

HIDA Scan CPT Code Modifiers 

The following are the list modifiers when CPT 78226 and 78227 bills: 

• 22, 23, 26, 52, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, ET, EY, FX, FY, GA, GC, GK, GR, GU, GY, GZ, KX, PT, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS. 

The most frequent bill modifiers are 26, TC, 77, 76, 59, or X {E, P, S, U} with CPT 78226 and 78227.   

Modifier 26 bills to indicate the professional component of services when attached with CPT 78226 and 78227. It shows that the Physician work as an employee in a hospital and facility, not owning the equipment. 

Modifier TC applicable with CPT 78226 and 78227 indicates the Technical component or machinery used in service. It usually bills with Hospital and facility claims. 

CPT 78226 and 78227 bills globally when physician-owned the office and equipment. Service bills without TC and 26 modifiers.

Modifier 76 is applicable with CPT CPT 78226 and 78227 when a similar service performs by the Same Physician on the same day. 

Modifier 76 is applicable with CPT CPT 78226 and 78227 when a similar service performs by a different Physician on the same service date.

Modifier 59 is applicable with CPT CPT 78226 and 78227 when Distinct service performs by the Physician and bundled with another procedure on the same date.  

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 78226 and 78227 when service bills to medicare insurance. It divides Modifier into four different parts for further specification of the procedure.

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and 78226 and 78227 must apply the GA modifier to that service.

Modifier 52 is applicable when the Physician cannot complete the procedure due to unavoidable circumstances. 

HIDA Scan CPT Code Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate. 

The following are ICD 10 Payable Dx codes:

C23, C24.9, C78.7, C78.89, D01.5, D13.4, D13.5, D37.6, K76.5, K76.89, K80.00, K80.01, K80.10, K80.11, K80.12, K80.13, K80.18, K80.19, K80.20, K80.21, K80.30, K80.31, K80.32, K80.33, K80.34, K80.35, K80.36, K80.37, K80.40, K80.41, K80.42, K80.43, K80.44, K80.45, K80.46, and K80.47.

K80.50, K80.51, K80.60, K80.61, K80.62, K80.63, K80.64, K80.65, K80.66, K80.67, K80.70, K80.71, K80.80, K80.81, K81.0, K81.1 K81.2, K81.9, K82.0, K82.1, K82.2, K82.3, K82.4, K82.8, K82.9, K82.A1, K82.A2, K87, Q44.0, and Q44.1.

Diagnostic services and Follow-up care reports separately from the appropriate section in conjunction with CPT 78226 and 78227.

HCPCS level II codes report separately in combination with CPT 78226 and 78227. 

HIDA Scan CPT Code Examples

The following are the examples of when HIDA Scan CPT Code (78226 and 78227) are billed:

Example 1

A 59-year-old female presents to the office with right upper quadrant pain for three days. She did take medication for pain, but the issue was not resolved. The pain is getting worse while eating. 

The patient denies any recent travel, dizziness, nausea, vomiting, extremity swelling, headache, numbness, chest pain, shortness of breath, and urinary problem.

The physical exam shows swelling in the upper quadrant region. He ordered laboratory and radiology tests such as MRI and CT of the chest. Studies were unremarkable.

The Physician consulted with the radiologist for further treatment. He suggested a Nuclear imaging scan of live and bile ducts. 

The Physician ordered HIDA scans to confirm the diagnosis. HID scans show abnormalities in the liver. The Physician scheduled follow-up studies for the next week and ordered an additional diagnostic test for the liver.

Example 2

A 79-year-old male presents to the office with multiple gallstones and has had pain for three days. She did take medication for pain, but the issue was not resolved. The pain is getting worse while eating. 

The patient denies any recent travel, dizziness, nausea, vomiting, extremity swelling, headache, numbness, chest pain, shortness of breath, and urinary problem.

The physical exam shows swelling in the upper quadrant region. He ordered laboratory and radiology tests such as MRI and CT of the chest. Studies were unremarkable.

The Physician consulted with the radiologist for further treatment. He suggested a HIDA scan and scheduled an appointment. 

The Physician ordered HIDA scans to confirm the diagnosis. HIDA scans show an elevated size of gallstone than earlier. The Physician scheduled follow-up studies for the next week and ordered the additional diagnostic test.