Three-phase nuclear medicine bone scan capturing blood flow, blood pool, and delayed bone images to evaluate a specific area of concern.
- Medicare
- $303.28
- Work RVU
- 0.99
- 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 ↓
- Indication, such as suspected osteomyelitis, prosthetic loosening, CRPS, or occult fracture
- Prior workup completed, such as X-rays, ESR, CRP, or aspiration
- Area of concern targeted
- Radiopharmaceutical and dose
- Findings for all three phases
- 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 ↓
In a three-phase scan, the flow and blood pool images are taken right after the tracer injection, and the delayed images come hours later. That sequence helps separate soft tissue from bone processes. Orthopedic uses include suspected osteomyelitis, periprosthetic infection versus aseptic loosening after a joint replacement, complex regional pain syndrome, and occult stress fractures.
It is coded once per study. Do not add 78300 or 78305 for the delayed images of the same area. Those are part of the three-phase study. SPECT or SPECT/CT, if added, goes on its own code from the 788xx series.
For periprosthetic workups, payers expect labs and aspiration first. A three-phase scan ordered before ESR, CRP, and joint aspiration is a common reason for a medical necessity denial or a peer-to-peer call. Document what has already been done and why the scan is the next step.
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 (0.99) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.08) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.99 |
| Practice expense RVU | 7.99 |
| Malpractice RVU | 0.1 |
| Total RVU | 9.08 |
| Medicare national rate | $303.28 |
| 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 | $303.28 |
HOPD (APC 5591) Hospital outpatient department | $408.43 |
Common denial reasons
The recurring reasons claims for CPT 78315 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Planar bone scan codes billed in addition for the delayed images
- Prior workup not documented for a periprosthetic question
- No prior authorization
- Radiopharmaceutical missing from the claim
- Diagnosis does not support a three-phase study
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01Can 78315 be billed with 78305?
02Is a three-phase bone scan used for a painful knee replacement?
03Is the tracer billed separately for 78315?
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 captures the prior labs, aspiration results, and imaging in the visit note, so the three-phase scan reads as a logical next step.
See how Mira captures CPT 78315 documentation