Nuclear medicine bone scan imaging multiple areas of the skeleton after injection of a bone-seeking radiotracer, using planar images.
- Medicare
- $242.82
- Work RVU
- 0.81
- Global, days
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 2 cited references ↓
- Clinical indication, such as suspected metastases, occult fracture, or multifocal pain
- Areas imaged, supporting multiple-area extent
- Radiopharmaceutical name and dose
- Findings by region
- Signed interpretation
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 2 cited references ↓
Planar imaging of several skeletal areas goes to 78305. Orthopedics orders it to look for metastatic disease, multifocal stress injuries, or occult fractures when X-rays are negative and MRI is not an option, for example a patient with a pacemaker or extensive hardware. It is also used to find additional lesions after one is seen on a plain film.
It sits between the limited study (78300, one area) and the whole-body study (78306). Pick the code by the extent actually imaged, not by what was ordered. A whole-body sweep is 78306, and billing it as 78305 or the reverse is a common mismatch.
The radiopharmaceutical is billed separately with its HCPCS supply code by whoever buys it. SPECT and SPECT/CT have their own codes in the 788xx series. If the radiologist adds either one, code it separately and check how the payer handles planar plus SPECT on the same day. Many commercial payers require prior authorization for nuclear medicine bone imaging.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.81) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.27) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.81 |
| Practice expense RVU | 6.37 |
| Malpractice RVU | 0.09 |
| Total RVU | 7.27 |
| Medicare national rate | $242.82 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $242.82 |
HOPD (APC 5591) Hospital outpatient department | $408.43 |
Common denial reasons
The recurring reasons claims for CPT 78305 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Extent imaged matches whole-body (78306) or limited (78300) instead
- Radiopharmaceutical not billed or billed by the wrong party
- No prior authorization
- Diagnosis does not support multi-site imaging
- MRI would have been the expected study and no reason is documented for bone scan
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01What is the difference between 78300, 78305, and 78306?
02Is the radiotracer included in 78305?
03When would an orthopedist order a bone scan instead of MRI?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/physician
Mira Scribe
Mira Scribe records why MRI is not an option, such as an implanted device or hardware, along with the areas of concern, which supports the bone scan order.
See how Mira captures CPT 78305 documentation