CPT code 78070 – Parathyroid planar imaging

Key takeaways

CPT code 78070 reports parathyroid planar imaging, including subtraction when performed, with no SPECT or CT acquisition.

One tracer, usually Tc-99m sestamibi (A9500), is enough to report the code, and a second agent is billed only when subtraction is performed.

Add SPECT and the code becomes 78071, while SPECT with concurrently acquired CT makes it 78072.

E21.0 (primary hyperparathyroidism) is the most common paired ICD-10 code, and weak diagnosis linkage is a leading denial trigger.

Renal-origin secondary hyperparathyroidism is coded N25.81, so E21.1 only fits non-renal secondary disease.

CPT code 78070 covers planar parathyroid imaging

CPT code 78070 is the code for parathyroid planar imaging (including subtraction, when performed), as defined in the American Medical Association’s CPT code set.

It reports static two-dimensional scintigraphy that localizes abnormal parathyroid tissue, most often an adenoma. The surgeon then uses the images to plan the parathyroidectomy, which is billed separately under 60500.

Before 2014, the code read simply “Parathyroid imaging.” The 2014 revision gave it its current wording and added 78071 and 78072 for studies with tomographic acquisition.

Most protocols use a single tracer, Tc-99m sestamibi, imaged at an early and a delayed time point. Parathyroid adenomas tend to hold on to sestamibi longer than thyroid tissue, so they stand out on the delayed images.

Some sites also give a thyroid-only agent and digitally subtract the thyroid image. That step is optional, and 78070 covers the study either way.

Technologists acquire planar images in anterior and oblique projections, typically 10 to 20 minutes and 2 to 3 hours after injection. A nuclear medicine physician then interprets the images and issues a written report. No tomographic reconstruction is performed, and that single fact decides the code.

Each tracer goes on its own HCPCS line

With the procedure defined, the next question is the supply side. The radiopharmaceutical isn’t part of 78070, so each agent given goes on its own line with a HCPCS Level II code.

A single-tracer study carries one supply line, usually A9500. A second agent appears on the claim only when the study included subtraction.

In the hospital outpatient setting, Medicare packages diagnostic radiopharmaceuticals into the procedure payment. The HCPCS line is still reported, though. Check the current status and billing units for A9500, A9516 and A9512 in the CMS quarterly HCPCS update before each plan year.

Medical necessity starts with confirmed hyperparathyroidism

CPT code 78070 is ordered mainly in two situations. The first is preoperative localization of an adenoma in a patient with confirmed primary hyperparathyroidism. The second is persistent or recurrent disease after a prior parathyroidectomy.

Both need biochemical confirmation before imaging is appropriate.

• Primary hyperparathyroidism (E21.0): Elevated serum calcium with inappropriately elevated or normal-high PTH, confirmed on two separate measurements. Scintigraphy localizes the adenoma before minimally invasive parathyroidectomy.
• Non-renal secondary hyperparathyroidism (E21.1): A less common indication, where imaging supports surgical planning after medical management has failed. Renal-origin secondary hyperparathyroidism is coded N25.81, not E21.1.
• Persistent or recurrent hyperparathyroidism after parathyroidectomy: Reoperative neck surgery carries higher risk, and precise localization reduces surgical morbidity.
• Suspected multiglandular disease: When four-gland hyperplasia is possible, mapping the abnormal glands beforehand shapes the surgical strategy.

Payers want the reasoning in the chart, not just a diagnosis code on the claim. The ordering note should carry the calcium and PTH values behind the workup. The PTH assay is its own lab service, billed under 83970, and its result is what makes the scan necessary.

The ICD-10 code has to match the chart

Accurate ICD-10-CM linkage is the most reliable way to head off a medical necessity denial. Use the most specific code that matches the documented clinical picture.

E21.3 (hyperparathyroidism, unspecified) is a fallback, so don’t submit it when the record documents primary disease and supports E21.0.

For lookups between procedure and diagnosis codes, CrossCoder offers CPT-to-ICD-10 crosswalks and coverage lookups by MAC jurisdiction. Ask your MAC whether a Local Coverage Determination for parathyroid imaging applies in your region, since criteria can differ.

SPECT or CT turns 78070 into 78071 or 78072

Once the diagnosis is settled, the acquisition decides the procedure code. CPT 78071 adds SPECT to the same parathyroid study, and 78072 adds SPECT with concurrently acquired CT.

Both include the planar images, so the diagram below works from the record outward.

Picking the wrong code cuts both ways. Billing 78070 after a SPECT acquisition underpays the study. Reporting 78071 or 78072 for planar-only images is overcoding.

Code from what the acquisition record shows was performed. If an order for planar imaging ends in a SPECT acquisition, reconcile it with the ordering physician before the claim goes out.

Modifiers follow who owns the camera

Modifier choice depends on how the technical facility and the interpreting physician split the service. Get the split wrong and nuclear medicine claims bounce routinely.

Five records make a 78070 claim defensible

A defensible claim for CPT code 78070 needs documentation at three points: the order, the procedure record and the final report. If one is missing, the claim is open to a medical necessity or services-not-rendered denial.

These five records cover all three.

• Ordering note: The ordering physician documents the clinical indication and the relevant calcium and PTH values. The note also explains why nuclear localization was chosen over ultrasound or 4D CT.
• Radiopharmaceutical administration record: Each agent’s name, HCPCS code, lot number, dose, route, injection time and the administering technologist. This record supports every tracer line, including a second agent used for subtraction.
• Acquisition parameters: Camera type, collimator, matrix size, acquisition times and number of views. These confirm planar-only imaging and support 78070 over 78071 or 78072.
• Physician interpretation and report: The interpreting physician’s name and credentials, the tracers used and image quality. The report also gives findings for each parathyroid and thyroid region, plus an impression tied to the indication.
• Supervision level: Check the physician supervision indicator for 78070 in the Medicare Physician Fee Schedule. Then record the level of supervision provided in the procedure record.

If you build structured fields into your superbill documentation, map each of these five records to its own field rather than free text. Structured capture means fewer omissions at claim submission.

Coverage and prior authorization vary by payer

Medicare covers parathyroid scintigraphy when documented biochemical hyperparathyroidism establishes medical necessity and the imaging supports surgical planning.

Payment rates are updated each year in the CMS Physician Fee Schedule. Look up current facility and non-facility rates for your locality rather than relying on last year’s figures.

Prior authorization rules change by payer and plan year, so capture the authorization before the date of service rather than after a denial.

• Medicare fee-for-service: No prior authorization is required in most cases. ICD-10 linkage and clinical documentation in the record support medical necessity.
• Medicare Advantage: Prior authorization is commonly required. Obtain and document the authorization number before the procedure date.
• Commercial payers: Policies vary widely. Some use radiology benefits management (RBM) carve-outs that need separate authorization through a third-party vendor.
• Medicaid: Coverage and authorization requirements differ by state, so confirm them against the state Medicaid fee schedule.

How a 78070 claim moves from order to payment

Coverage rules set the conditions, and the workflow below is how a billing team meets them. A clean claim on the first pass gets paid faster than a denied one gets worked.

1. Verify eligibility and authorization: Confirm active coverage and obtain prior authorization from Medicare Advantage or commercial payers. Record the authorization number in the patient chart before the procedure date.
2. Confirm ICD-10 linkage: Review the ordering note for documented biochemical hyperparathyroidism. Select the most specific E21.x or D35.1 code the record supports.
3. Capture radiopharmaceutical data: Record HCPCS codes, doses, lot numbers and administration times at the point of care. This data feeds the A9500 line, plus an A9516 or A9512 line when subtraction was performed.
4. Set the modifier and billing split: Confirm whether the claim is global, professional component (-26) or technical component (-TC). Mismatched splits between the physician and facility claims create recoupment risk.
5. Submit the claim: Send the 837P electronically through your clearinghouse once the eligibility check has cleared.
6. Reconcile the ERA: Review the electronic remittance advice for every line, tracer lines included. Underpaid tracer lines go unnoticed when teams check only the procedure code payment.

Here’s a worked example. A radiologist reads a planar-only sestamibi study performed at a hospital. The radiologist bills 78070-26, linked to E21.0. The hospital bills the technical service and the A9500 line on its own facility claim. No second tracer line appears, because no subtraction was done.

Run this checklist before you submit

A two-minute check at the end of the workflow catches most of the errors that cause rework. Tick each item before the claim leaves.

• The acquisition record shows planar images only, with no SPECT or CT.
• The ordering note carries calcium and PTH values that support the indication.
• The diagnosis is the most specific E21.x or D35.1 code the chart supports, not E21.3 by default.
• Each tracer given has its own HCPCS line, and a second agent appears only with subtraction.
• The modifier matches who owns the equipment and who read the study.
• An authorization number is on file for Medicare Advantage and commercial plans.

Five mistakes that get 78070 claims denied

Even with a checklist, denials for parathyroid scintigraphy follow a predictable pattern. Effective denial management strategies start by finding which mistake drives the most volume in your payer mix.

• Wrong code selection (78070 vs. 78071 or 78072): Billing 78070 when SPECT was performed leaves money on the table. Reporting 78071 or 78072 for planar-only images creates overcoding exposure. The acquisition protocol in the procedure record is the audit trail.
• Missing prior authorization: Medicare Advantage and many commercial plans require it, and a claim without a valid authorization number is denied automatically. Build an authorization checkpoint into scheduling.
• Inadequate ICD-10 linkage: Submitting E21.3 when E21.0 was documented, or linking no diagnosis at all, triggers medical necessity review. Match the claim diagnosis to the ordering note.
• Bundled radiopharmaceutical lines: Some clearinghouses fold HCPCS tracer lines into the procedure line. Confirm that A9500, plus A9516 or A9512 when subtraction was performed, reach the payer as separate lines with their own charges.
• Supervision level mismatch: Medicare sets a required supervision level for the code. If the record shows less, expect a documentation request or denial.

A study performed with one tracer is not a valid reason to deny 78070. The descriptor covers subtraction only “when performed,” so appeal any denial that rests on a missing second agent.

How Pabau gets 78070 claims to the payer cleanly

Many nuclear medicine billing teams check coverage in one tool and submit claims in another. Authorization status and tracer lines then get re-keyed between them, and that’s where errors creep in.

Pabau, the practice management platform we build, keeps both steps together. Its claims management software runs eligibility checks before the scan and submits claims electronically through Claim.MD in the US. Practices in the UK and Australia submit through Healthcode and Tyro Health.

Coverage gets confirmed before the date of service, so fewer claims come back for authorization problems. Your coders still choose the code and modifiers, and Pabau gets the finished claim to the payer.

Check eligibility and submit claims in one place

Pabau checks patient eligibility before the scan and submits claims electronically through Claim.MD, so your team spends less time chasing authorization denials.

Book a demo

Conclusion

Code parathyroid imaging from the acquisition record. If the images are planar only, 78070 is correct whether the study used one tracer or two. SPECT moves the claim to 78071, and SPECT with concurrent CT moves it to 78072.

Bill a second tracer only when subtraction was performed, and never hold a single-tracer claim for a missing agent. Spend that effort on prior authorization and diagnosis specificity instead. Those are the denial triggers you control before the scan.

If your team still re-keys authorization details between tools, that’s the step worth fixing first. Book a demo to see how Pabau confirms eligibility before the scan and sends the 78070 claim through Claim.MD.

Continue your research

Need a structured approach to claim rejections? Denial codes in medical billing covers the most common CARC and RARC codes and what each signals about your claim.

Unsure how clearinghouse submissions work? Medical claims clearinghouse explains how 837P files move from your practice management system to payers and what can go wrong in transit.

Want to reduce time spent on eligibility checks? Insurance eligibility verification outlines automated verification workflows that flag coverage problems before the date of service.

Billing thyroid scans as well? CPT code 78014: Thyroid imaging with uptake walks through the neighboring endocrine nuclear medicine code.

Frequently asked questions