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Billing code 78445: Vascular flow studyMedicare rate & RVUs

Reports radionuclide imaging used to assess blood flow through a selected vascular territory when clinicians need a functional flow study.

CMS RVU26DEffective Oct 1, 2026109 payment localities49 Medicare services in 2024

Medicare pays $167.00 for 78445 nationally in the office. Local office rates run $144.91–$233.38.

Medicare rate · 78445

Vascular flow study

Swap in your local Medicare rate.

Work RVUs
0.48
Total RVUs
5.00
Global days
XXX

National rate · 2026

$167.00

Office setting, before claim adjustments.

See every locality for 78445 → · Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 78445 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 78445 covers

This nuclear medicine study uses a radiotracer and imaging to assess blood movement through a selected vascular territory. It may be ordered when a clinician is evaluating suspected impaired circulation, including limb perfusion concerns. Nuclear medicine technologists acquire the study, and a qualified physician interprets the images. The service is generally performed in a hospital or other diagnostic imaging facility.

Report 78445 for the vascular flow imaging service, supported by documentation identifying the clinical indication, vascular territory examined, imaging performed, and physician interpretation. The code has professional and technical components: report modifier 26 for the interpretation, TC for the equipment and staff, or no modifier for the global service. When multiple cardiovascular diagnostic procedures are performed, the multiple procedure reduction applies to 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 78445 pays more and less

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

109 payment localities

$144.91 to $233.38

$144.91$189.14$233.38
One dot per payment locality, office / nonfacility. Hover a dot to see the locality; select it to open that rate.

109 of 109 payment localities

78445 office and facility rates by payment locality
Payment localityOfficeFacility
Alabama$147.41Unavailable
Alaska*$183.63Unavailable
Arizona$162.06Unavailable
Arkansas$144.91Unavailable
Atlanta$169.90Unavailable
Austin$175.39Unavailable
Bakersfield$180.66Unavailable
Baltimore/Surr. Cntys$178.67Unavailable
Beaumont$153.46Unavailable
Brazoria$165.28Unavailable

78445 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$144.91

$206.92

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
78445 office rate range by state
State / territoryOffice rate rangeLocalities
AK$183.631
AL$147.411
AR$144.911
AZ$162.061
CA$180.46–$233.3829
CO$176.201
CT$179.261
DC$194.591
DE$165.061
FL$161.64–$176.673
GA$151.40–$169.902
GU$186.381
HI$186.381
IA$152.961
ID$153.881
IL$155.39–$172.934
IN$154.951
KS$151.581
KY$150.311
LA$149.81–$158.552
MA$174.66–$196.242
MD$168.76–$194.593
ME$154.23–$164.802
MI$154.37–$163.412
MN$169.671
MO$146.43–$159.873
MS$145.731
MT$167.001
NC$156.201
ND$165.621
NE$154.111
NH$172.811
NJ$181.55–$191.952
NM$155.141
NV$166.761
NY$158.88–$198.135
OH$154.091
OK$150.581
OR$165.72–$183.162
PA$154.69–$173.842
PR$168.601
RI$171.961
SC$155.361
SD$165.451
TN$152.401
TX$153.46–$175.398
UT$157.851
VA$163.79–$194.592
VI$168.601
VT$164.361
WA$174.53–$201.122
WI$159.141
WV$148.541
WY$166.401

How the 78445 rate is calculated

Each of 78445’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.

How the rate is built · 78445

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 0.48Practice expense 4.45Malpractice 0.07

5.0000 adjusted RVUs×$33.4009 conversion factor=$167.00

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 78445

The CMS indicators that decide how 78445 is paid alongside other services.

CMS payment indicators · 78445

Vascular flow study

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures6Diagnostic cardiovascular reduction applies to the technical component.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical1Diagnostic test with separate professional (26) and technical (TC) components.

What modifiers do to the payment

Modifier 26 · payment effect

With and without the modifier

78445 without 26 · national office

$167.00

Vascular flow study

78445-26 · Professional component

$22.71

Pays only the interpretation and report.

When to use modifier 26

78445 compared with similar codes

Compare codes

78445 vs 78456 vs 78457 vs 78458: national Medicare rates

Swap in your local Medicare rate.

  • 78445
    Vascular flow study · 0.48 wRVU
    $167.00
  • 78456
    Venous thrombosis imaging · 0.98 wRVU
    $284.24+$117.24
  • 78457
    Venous imaging · 0.75 wRVU
    $167.34+$0.34
  • 78458
    Venous imaging · 0.88 wRVU
    $186.04+$19.04

How to choose

78456Venous thrombosis imaging
78456 is directed to acute venous thrombosis imaging. Choose 78445 for a vascular flow study that is not specifically an acute thrombus examination.
78457Venous imaging
78457 describes venous thrombosis imaging focused on venous flow. 78445 is the broader vascular flow study selection.
78458Venous imaging
78458 is the bilateral venous thrombosis imaging option. 78445 is not distinguished by a bilateral venous thrombosis study.

Codes related to 78445

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

Codes related to 78445
CodeHow it relatesNational office range
Used instead
78456Venous thrombosis imagingA dedicated acute venous thrombosis imaging option when the clinical question is acute thrombus.$247.86–$396.59
78457Venous imagingVenous thrombosis imaging for a study directed specifically at venous flow or thrombosis.$146.47–$230.87
78458Venous imagingBilateral venous thrombosis imaging when the study is directed to both sides.$162.92–$255.79

78445 billing questions

When is 78445 preferable to venous thrombosis imaging?

Use 78445 for a vascular flow study. When the clinical question is specifically venous thrombosis, compare the dedicated thrombosis imaging options, such as 78456 or 78457.

How should the professional and technical portions be reported?

Use modifier 26 for the physician's interpretation and TC for the technical service. Reporting without either modifier represents the global service.

Does the multiple procedure reduction affect both components?

The cardiovascular diagnostic multiple procedure reduction applies to the technical component when multiple qualifying procedures are performed.

What documentation supports reporting 78445?

Document the reason for the study, the vascular territory imaged, the imaging performed, and the physician's interpretation of the flow findings.

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

Show the CMS file lines behind this rate
RVUs for 78445PPRRVU2026_Oct_nonQPP.csv, line 9,362 (RVU26D)

Open CMS sourceHow we calculate rates

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