Billing code 78457: Venous imagingMedicare rate & RVUs
Reports radionuclide venous thrombosis imaging of one side when a clinician needs imaging to assess venous flow and possible thrombus.
Medicare pays $167.34 for 78457 nationally in the office. Local office rates run $146.47–$230.87.
Medicare rate · 78457
Venous imaging
Swap in your local Medicare rate.
- Work RVUs
- 0.75
- Total RVUs
- 5.01
- Global days
- XXX
National rate · 2026
$167.34
Office setting, before claim adjustments.
See every locality for 78457 → · 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
What 78457 covers
This nuclear medicine study uses a radiopharmaceutical and imaging to assess venous flow and identify findings relevant to venous thrombosis on one side. It may be ordered when a clinician is evaluating suspected venous clot; a nuclear medicine technologist performs image acquisition, and a qualified physician interprets the study. The code distinguishes a unilateral examination from the bilateral study in the same code family.
Report one unit for the unilateral study and document the side examined, the clinical question, the imaging performed, and the physician’s interpretation. The code has professional and technical components: report modifier 26 for interpretation, modifier TC for the equipment and staff service, or neither modifier when billing the global service. When multiple cardiovascular diagnostic procedures are performed, the CMS 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 78457 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
$146.47 to $230.87
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $148.83 | Unavailable |
| Alaska* | $187.91 | Unavailable |
| Arizona | $162.66 | Unavailable |
| Arkansas | $146.47 | Unavailable |
| Atlanta | $170.12 | Unavailable |
| Austin | $175.24 | Unavailable |
| Bakersfield | $180.34 | Unavailable |
| Baltimore/Surr. Cntys | $178.51 | Unavailable |
| Beaumont | $154.58 | Unavailable |
| Brazoria | $165.76 | Unavailable |
| Chicago | $171.24 | Unavailable |
| Chico | $180.11 | Unavailable |
| Colorado | $176.08 | Unavailable |
| Connecticut | $179.11 | Unavailable |
| Dallas | $166.67 | Unavailable |
| Dc + Md/Va Suburbs | $193.87 | Unavailable |
| Delaware | $165.55 | Unavailable |
| Detroit | $164.04 | Unavailable |
| East St. Louis | $158.51 | Unavailable |
| El Centro | $180.13 | Unavailable |
| Fort Lauderdale | $171.05 | Unavailable |
| Fort Worth | $165.30 | Unavailable |
| Fresno | $180.11 | Unavailable |
| Galveston | $166.16 | Unavailable |
| Hanford-Corcoran | $180.11 | Unavailable |
| Hawaii, Guam | $185.53 | Unavailable |
| Houston | $167.44 | Unavailable |
| Idaho | $154.91 | Unavailable |
| Indiana | $155.92 | Unavailable |
| Iowa | $154.03 | Unavailable |
| Kansas | $152.74 | Unavailable |
| Kentucky | $151.61 | Unavailable |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $193.19 | Unavailable |
| Madera | $180.11 | Unavailable |
| Manhattan | $192.98 | Unavailable |
| Merced | $180.11 | Unavailable |
| Metropolitan Boston | $195.26 | Unavailable |
| Metropolitan Kansas City | $158.75 | Unavailable |
| Metropolitan Philadelphia | $173.98 | Unavailable |
| Metropolitan St. Louis | $160.63 | Unavailable |
| Miami | $176.65 | Unavailable |
| Minnesota | $169.75 | Unavailable |
| Mississippi | $147.28 | Unavailable |
| Modesto | $180.11 | Unavailable |
| Montana** | $167.33 | Unavailable |
| Napa | $212.27 | Unavailable |
| Nebraska | $155.11 | Unavailable |
| Nevada** | $167.09 | Unavailable |
| New Hampshire | $172.78 | Unavailable |
| New Mexico | $156.19 | Unavailable |
| New Orleans | $159.40 | Unavailable |
| North Carolina | $157.12 | Unavailable |
| North Dakota** | $165.95 | Unavailable |
| Northern Nj | $191.47 | Unavailable |
| Nyc Suburbs/Long Island | $197.40 | Unavailable |
| Ohio | $155.18 | Unavailable |
| Oklahoma | $151.84 | Unavailable |
| Oxnard-Thousand Oaks-Ventura | $192.63 | Unavailable |
| Portland | $182.68 | Unavailable |
| Poughkpsie/N Nyc Suburbs | $182.25 | Unavailable |
| Puerto Rico | $168.84 | Unavailable |
| Queens | $195.45 | Unavailable |
| Redding | $180.11 | Unavailable |
| Rest Of California | $180.11 | Unavailable |
| Rest Of Florida | $162.36 | Unavailable |
| Rest Of Georgia | $152.67 | Unavailable |
| Rest Of Illinois | $156.48 | Unavailable |
| Rest Of Louisiana | $151.15 | Unavailable |
| Rest Of Maine | $155.26 | Unavailable |
| Rest Of Maryland | $169.08 | Unavailable |
| Rest Of Massachusetts | $174.68 | Unavailable |
| Rest Of Michigan | $155.46 | Unavailable |
| Rest Of Missouri | $147.96 | Unavailable |
| Rest Of New Jersey | $181.44 | Unavailable |
| Rest Of New York | $159.65 | Unavailable |
| Rest Of Oregon | $166.08 | Unavailable |
| Rest Of Pennsylvania | $155.73 | Unavailable |
| Rest Of Texas | $159.97 | Unavailable |
| Rest Of Washington | $174.52 | Unavailable |
| Rhode Island | $172.18 | Unavailable |
| Riverside-San Bernardino-Ontario | $180.88 | Unavailable |
| Sacramento-Roseville-Folsom | $189.97 | Unavailable |
| Salinas | $189.28 | Unavailable |
| San Diego-Chula Vista-Carlsbad | $194.45 | Unavailable |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $225.83 | Unavailable |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $225.75 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $230.87 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $230.54 | Unavailable |
| San Luis Obispo-Paso Robles | $186.13 | Unavailable |
| Santa Cruz-Watsonville | $196.87 | Unavailable |
| Santa Maria-Santa Barbara | $190.19 | Unavailable |
| Santa Rosa-Petaluma | $198.91 | Unavailable |
| Seattle (King Cnty) | $199.93 | Unavailable |
| South Carolina | $156.35 | Unavailable |
| South Dakota** | $165.79 | Unavailable |
| Southern Maine | $165.22 | Unavailable |
| Stockton | $180.11 | Unavailable |
| Suburban Chicago | $173.10 | Unavailable |
| Tennessee | $153.52 | Unavailable |
| Utah | $158.70 | Unavailable |
| Vallejo | $212.16 | Unavailable |
| Vermont | $164.78 | Unavailable |
| Virgin Islands | $168.84 | Unavailable |
| Virginia | $164.27 | Unavailable |
| Visalia | $180.11 | Unavailable |
| West Virginia | $150.01 | Unavailable |
| Wisconsin | $159.84 | Unavailable |
| Wyoming** | $166.73 | Unavailable |
| Yuba City | $180.11 | Unavailable |
78457 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$146.47
$205.49
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $187.91 | 1 |
| AL | $148.83 | 1 |
| AR | $146.47 | 1 |
| AZ | $162.66 | 1 |
| CA | $180.11–$230.87 | 29 |
| CO | $176.08 | 1 |
| CT | $179.11 | 1 |
| DC | $193.87 | 1 |
| DE | $165.55 | 1 |
| FL | $162.36–$176.65 | 3 |
| GA | $152.67–$170.12 | 2 |
| GU | $185.53 | 1 |
| HI | $185.53 | 1 |
| IA | $154.03 | 1 |
| ID | $154.91 | 1 |
| IL | $156.48–$173.10 | 4 |
| IN | $155.92 | 1 |
| KS | $152.74 | 1 |
| KY | $151.61 | 1 |
| LA | $151.15–$159.40 | 2 |
| MA | $174.68–$195.26 | 2 |
| MD | $169.08–$193.87 | 3 |
| ME | $155.26–$165.22 | 2 |
| MI | $155.46–$164.04 | 2 |
| MN | $169.75 | 1 |
| MO | $147.96–$160.63 | 3 |
| MS | $147.28 | 1 |
| MT | $167.33 | 1 |
| NC | $157.12 | 1 |
| ND | $165.95 | 1 |
| NE | $155.11 | 1 |
| NH | $172.78 | 1 |
| NJ | $181.44–$191.47 | 2 |
| NM | $156.19 | 1 |
| NV | $167.09 | 1 |
| NY | $159.65–$197.40 | 5 |
| OH | $155.18 | 1 |
| OK | $151.84 | 1 |
| OR | $166.08–$182.68 | 2 |
| PA | $155.73–$173.98 | 2 |
| PR | $168.84 | 1 |
| RI | $172.18 | 1 |
| SC | $156.35 | 1 |
| SD | $165.79 | 1 |
| TN | $153.52 | 1 |
| TX | $154.58–$175.24 | 8 |
| UT | $158.70 | 1 |
| VA | $164.27–$193.87 | 2 |
| VI | $168.84 | 1 |
| VT | $164.78 | 1 |
| WA | $174.52–$199.93 | 2 |
| WI | $159.84 | 1 |
| WV | $150.01 | 1 |
| WY | $166.73 | 1 |
How the 78457 rate is calculated
Each of 78457’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 · 78457
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.75Practice expense 4.19Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78457
The CMS indicators that decide how 78457 is paid alongside other services.
CMS payment indicators · 78457
Venous imaging
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 6 | Diagnostic cardiovascular reduction applies to the technical component. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
78457 without 26 · national office
$167.34
Venous imaging
78457-26 · Professional component
$35.40
Pays only the interpretation and report.
78457 compared with similar codes
Compare codes
78457 vs 78458 vs 78456 vs 93971: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 78458Venous imaging
- Use 78457 for a unilateral study and 78458 when imaging is performed bilaterally.
- 78456Venous thrombosis imaging
- 78456 identifies acute venous thrombus imaging; 78457 is the unilateral venous thrombosis imaging code. Select based on the study performed and its documented purpose.
- 93971Venous duplex scan
- 93971 reports a unilateral venous duplex ultrasound examination. 78457 is radionuclide venous thrombosis imaging, a different imaging method.
78457 billing questions
How does 78457 differ from 78458?
78457 is for imaging on one side; 78458 is the bilateral study. The documented extent of the examination determines which code fits.
When should 78456 be considered instead?
78456 is the code identified for acute venous thrombus imaging. Use the code that matches the type of study performed and documented rather than choosing by code proximity.
Can the professional and technical services be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service. Bill without either modifier when reporting the global service.
Does the multiple procedure reduction affect both components?
The CMS cardiovascular diagnostic multiple procedure reduction applies to the technical component. It does not apply to the professional component under the rule provided for this code.
What documentation supports a unilateral claim?
Document the side imaged, the clinical indication, the examination performed, and the interpretation. The record should support that the study covered one side rather than both.
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
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