CPT code 78014 – Thyroid imaging with uptake

Key takeaways

CPT 78014 needs two elements in the report: thyroid images and at least one quantitative uptake percentage.

Images alone are 78013 and uptake alone is 78012, while extra uptake readings never change the code.

Bill the global code only when one provider performs and reads the scan. Otherwise, split it with modifiers TC and 26.

The 2026 national RVUs for 78014 total 6.31 in both facility and non-facility settings.

The tracer goes on its own HCPCS line, such as A9516, unless the payer bundles it into the imaging fee.

CPT code 78014 pays for thyroid images plus a measured uptake

CPT code 78014 is the nuclear medicine code for a thyroid scan that includes both images and at least one quantitative uptake measurement. The American Medical Association (AMA) maintains the official descriptor.

It reads: “Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed).”

Put simply, the code pays for two jobs done in one study. Images show the shape of the gland and any hot or cold areas. Meanwhile, the uptake reading shows how much tracer the thyroid absorbed. Flow images and any stimulation, suppression, or perchlorate discharge protocol come along without a separate code.

What happens during a 78014 study

An I-123 study usually runs across two days. Knowing the sequence tells you what the finished report should contain.

1. The patient swallows an I-123 sodium iodide capsule or receives an IV dose of technetium-99m pertechnetate.
2. The team measures uptake over the neck, most often at 4 to 6 hours and again at 24 hours after an I-123 dose.
3. Planar images of the thyroid follow. When blood flow matters, flow images are taken right after an IV injection.
4. If ordered, a TSH stimulation, T3 suppression, or perchlorate discharge protocol runs within the same study.
5. The reading physician signs a report covering the images, each uptake percentage, and an impression.

Images, uptake, or both decide between 78012, 78013 and 78014

Two questions settle the code. Were images acquired, and was uptake measured? Answer both before you read the rest of the report.

Here’s how that plays out. A single 24-hour reading and a 4-hour plus 24-hour pair both land on 78014. Images with no uptake value go to 78013. An uptake value with no images goes to 78012.

Does a second uptake reading pay more? No. The descriptor says “single or multiple,” so a second reading changes the report but not the code or the fee. Some older references still say 78014 needs two readings. That rule comes from the code set before 2013, when single and multiple uptakes had separate codes.

Diagnoses that prove 78014 was medically necessary

Medical necessity comes from the diagnosis on the claim. Payers publish local coverage determinations (LCDs) that list the diagnoses they accept. The pairings below are the most common ones, and you can confirm each descriptor in the ICD-10-CM codes library.

Coverage isn’t uniform, though. Some Medicare Administrative Contractors (MACs) limit 78014 to hyperthyroidism and exclude nodule workups, because ultrasound usually looks at nodules first.

That ultrasound is a separate service, billed as 76536. Check your MAC’s current LCD before you submit a claim with a nodule-only diagnosis.

Modifiers TC and 26 follow who reads the scan

Start with one question: who did which half of the work? The technical component covers the scan, the dose, and image acquisition. Interpretation and the signed report make up the professional component.

• No modifier (global billing): The same physician or group performs and interprets the scan. This is common in freestanding nuclear medicine practices.
• Modifier TC (technical component): The imaging center performs the scan but doesn’t read it. The interpreting physician bills separately.
• Modifier 26 (professional component): A radiologist or nuclear medicine physician reads the images for another facility. The claim covers the interpretation and report only.

Place of service (POS) codes show where the work happened. An office or freestanding imaging center uses POS 11. A hospital outpatient department uses POS 22 on campus or POS 19 off campus. Medicare lists the same RVUs for 78014 in both settings, so POS mostly decides who can bill which part.

CMS assigns 78014 a global period of XXX, so no pre- or post-procedure period applies. One same-day pairing needs extra care, though. If the patient also gets oral radioiodine therapy (CPT 79005) that day, Bracco’s reimbursement team advises adding modifier 59 or XU to 78014.

The radiopharmaceutical goes on its own claim line

The tracer is a supply, so it’s billed with a HCPCS Level II code next to 78014. These are the usual choices:

• A9516: I-123 sodium iodide capsule, per 100 microcuries, up to 999 microcuries.
• A9509: I-123 sodium iodide, per millicurie.
• A9512: Technetium-99m pertechnetate, per millicurie.

Unit counts trip up plenty of claims. Bill units that match the dose recorded on dose day, not the dose that was ordered. A 200-microcurie capsule, for example, is two units of A9516.

Giving the dose is a different matter. Medicare’s National Correct Coding Initiative (NCCI) policy treats administration as part of the nuclear medicine procedure, so don’t add an injection code for it.

Some commercial payers go further and fold the tracer itself into the imaging fee. Check each payer’s drug policy before you add the supply line.

CPT code 78014 carries 6.31 total RVUs in 2026

The 2026 Medicare Physician Fee Schedule (MPFS) gives 78014 a national total of 6.31 relative value units (RVUs). That figure is the same in facility and non-facility settings.

The CMS Physician Fee Schedule lookup tool is the authoritative source, and local Geographic Practice Cost Index (GPCI) adjustments apply on top.

To turn RVUs into dollars, multiply by the conversion factor. At the 2026 non-APM rate of $33.4009, 6.31 RVUs comes to about $210.76 before locality adjustment. Practice expense makes up most of that, which reflects the camera time and staff behind the scan.

Commercial contracts are usually priced as a percentage of Medicare. The FastRVU 2026 RVU lookup tool helps you check locality-adjusted amounts and benchmark those contracts.

Prior authorization hinges on who manages the plan’s imaging

Whether you need prior authorization depends on the payer, and the rules change often. Treat these 2026 patterns as a starting point, then confirm with each plan.

• Traditional Medicare Part B: Prior authorization isn’t required for 78014. Medicare Advantage plans may set their own rules, so check at the plan level.
• Carelon (formerly AIM Specialty Health): Manages nuclear medicine approvals for many Anthem-affiliated plans. Expect to send clinical notes that show thyroid dysfunction.
• Optum: Requires approval for nuclear medicine on most UnitedHealthcare commercial plans. Include the diagnosis and the planned next step, such as I-131 dose planning.
• eviCore: Handles requests for several Cigna and Aetna plans through its online portal. Its criteria follow the ACR Appropriateness Criteria for thyroid imaging.

A strong request includes the ordering physician’s NPI, the patient’s thyroid history, and current TSH and free T4 results. Name the planned protocol too, such as I-123 with 4- and 24-hour uptake. Denied approvals are far easier to prevent than to appeal, so confirm the requirement when the scan is booked.

How a 78014 claim moves from order to payment

A 78014 claim passes through six handoffs, and any one of them can stop it. The checkpoints below show what each stage has to produce.

Take a common case. An endocrinologist orders a scan for suspected Graves disease and codes E05.00. The plan’s radiology benefit manager approves it, and the patient takes a 200-microcurie I-123 capsule on Monday.

Uptake is measured that afternoon and again on Tuesday, when the images are taken. Once the report is signed, the office bills 78014 globally with two units of A9516. Had a hospital run the scan and billed the technical side, the physician would bill 78014-26 instead.

Six denials that hit 78014 claims, and how to fix them

When a 78014 claim comes back, the denial usually points to one of six causes. Each fix below covers the appeal and the process change that stops a repeat.

Track these by reason code rather than claim by claim. One report template that drops the uptake percentage can cause months of denials before anyone spots the pattern. The claim adjustment reason codes (CARCs) on each remittance tell you which checkpoint failed.

Documentation that backs up every 78014 claim

An auditor reviewing a 78014 chart looks for six items. Each should be in place before anyone builds the claim.

• Physician order: A written or electronic order naming thyroid imaging with uptake, the reason, and the ordering provider.
• Clinical indication: A progress note or referral explaining the need, such as new TSH suppression or suspected Graves disease.
• Radiopharmaceutical record: The agent, dose, route, lot number, and time given. Regulators and payer auditors both expect it.
• Uptake measurements: The uptake percentage for each time point, with timestamps. This is the field that separates 78014 from 78013.
• Protocol notes: Timing, doses, and rationale for any stimulation, suppression, or perchlorate discharge protocol.
• Signed interpretation: Findings, uptake values, and an impression, signed before the claim goes out.

Run this check before you hit submit

Next, compare the claim itself with the chart. It takes two minutes and catches the errors behind the denials above.

• The code matches the report, with images plus uptake for 78014.
• The ICD-10-CM code appears on your MAC’s LCD or the payer’s policy.
• The authorization number is on the claim and covers 78014.
• The modifier matches the billing setup: none, TC, or 26.
• The POS code matches where the scan took place.
• The supply line uses the right HCPCS code and unit count.
• The interpretation report is signed and dated.

How Pabau keeps 78014 claims clean before they go out

Many 78014 denials start with a detail that sat in the chart but never reached the claim. The uptake value lives in the report, and the auth number sits in an email. Then someone retypes both into the billing system.

Practice management software like Pabau shortens that handoff. Its claims management software pre-fills the CMS-1500 from the patient record, so the 78014 charge line and diagnosis slots arrive filled in. Billers can confirm codes in the built-in CPT, HCPCS, and ICD-10-CM libraries without leaving the claim.

The claim can’t be sent until required fields, such as the authorization number, are complete. US practices submit through Pabau’s Claim.MD connection, with real-time eligibility checks before the visit. Remittances post back with their reason codes, so a pattern of 78014 denials shows up as soon as payments arrive.

Stop chasing nuclear medicine denials manually

Pabau pre-fills CPT 78014 claims from the patient record, checks required fields like authorization codes, and posts ERA denials automatically. See how the workflow fits your nuclear medicine billing team.

Book a demo

Conclusion

CPT 78014 rewards precision more than volume. The code pays the same whether the report shows one uptake reading or three. What changes the outcome is whether the images, the uptake value, the diagnosis, and the approval all line up on paper.

So start with the report template. If it requires a timestamped uptake percentage and a signature before sign-off, the code-selection and documentation denials above lose their most common cause. The trade-off is a little more structure for your team on scan day.

Want the diagnosis, auth number, and charge line to reach the claim without retyping? Book a demo to see how Pabau carries a 78014 study from the patient record to a paid claim.

Continue your research

Need to understand how claims reach payers? Medical claims clearinghouse explained covers how electronic claims are validated, scrubbed, and routed to payers.

Dealing with repeated 78014 denials from one payer? Denial codes in medical billing maps common CARC and RARC codes to corrective actions.

Want to verify 837 file formatting for nuclear medicine claims? 837 file guide explains the transaction set structure and how to read a submission acknowledgment.

Need a step-by-step for payer approvals? Prior authorization process walks through each stage from request to approval.

Billing other nuclear medicine studies? CPT code 78803 covers single-area SPECT localization studies and how to bill them.

Frequently asked questions