Billing code 78428: Shunt imagingMedicare rate & RVUs

Medicare pays $171.01 for 78428 nationally in the office. Local office rates run $149.67–$236.05.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 78428 covers

This nuclear medicine study evaluates suspected abnormal blood flow between cardiac circulations and quantifies the shunt. The acquisition may include imaging, but the code covers shunt detection with or without images. A nuclear medicine technologist typically performs the technical work in a hospital or imaging department; a qualified physician interprets the study. It can support evaluation of a suspected congenital or acquired cardiac shunt when the clinician needs a quantitative assessment.

Report the study based on its shunt-evaluation purpose, not simply because cardiac imaging was performed. The record should identify the indication, document the study performed and its quantitative findings, and support the interpreting physician’s conclusion. Bill the global service without a component modifier, or report the professional interpretation with modifier 26 and the technical service with modifier TC. When the cardiovascular diagnostic multiple-procedure reduction applies, it affects the technical component.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 78428 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

78428 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 78428 rate is calculated

Each of 78428’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 78428

The CMS indicators that decide how 78428 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

78428 compared with similar codes

How to choose

78414Non-imaging heart function

78428 is directed at detecting and quantifying a cardiac shunt. 78414 is a non-imaging cardiac function study, so select according to the documented study objective.

78481Cardiac function imaging

78481 describes a single first-pass cardiac study. 78428 is selected for shunt detection and quantification, rather than simply because first-pass imaging was performed.

78483First-pass cardiac imaging

78483 describes multiple first-pass cardiac studies. Choose 78428 when the service is specifically a quantitative cardiac shunt study.

Codes related to 78428

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates