Non-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.
CMS RVU26D · Effective 2026-10-01
Office / nonfacility
$184.12
Base rate per service
Facility setting
Not available in this setting
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Nuclear medicine
Nuclear medicine testing that detects and quantifies abnormal blood flow between cardiac circulations, reported when the clinical question is a suspected cardiac shunt.
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.
154
Medicare services in 2024 · #4541 by national volume
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.
Office rates for Merced, from the same CMS release.
Non-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.
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.
78483 describes multiple first-pass cardiac studies. Choose 78428 when the service is specifically a quantitative cardiac shunt study.
The same code, a different location
In Bakersfield, the office rate for 78428 is $184.34—$0.22 higher than the $184.12 rate in Merced. Both use the same code, release and participation basis.
Same release and payment basis · bars start at $0
Merced · This locality
$184.12
$184.34
$0.22 higher than Merced
$184.12
The same base rate than Merced
$184.13
$0.01 higher than Merced
$184.12
The same base rate than Merced
$184.12
The same base rate than Merced
$13.37 higher than Merced
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
Across 109 of 109 CMS payment localities with a supported office rate, 78428 ranges from $149.67 in Arkansas to $236.05 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
California · 78428
Office
$184.12
Facility
Unavailable
The same base rate than Merced for the office setting.
California · 78428
Office
$184.12
Facility
Unavailable
The same base rate than Merced for the office setting.
California · 78428
Office
$217.03
Facility
Unavailable
$32.91 higher than Merced for the office setting.
California · 78428
Office
$196.92
Facility
Unavailable
$12.80 higher than Merced for the office setting.
California · 78428
Office
$184.12
Facility
Unavailable
The same base rate than Merced for the office setting.
California · 78428
Office
$184.12
Facility
Unavailable
The same base rate than Merced for the office setting.
California · 78428
Office
$184.88
Facility
Unavailable
$0.76 higher than Merced for the office setting.
California · 78428
Office
$194.20
Facility
Unavailable
$10.08 higher than Merced for the office setting.
California · 78428
Office
$193.50
Facility
Unavailable
$9.38 higher than Merced for the office setting.
California · 78428
Office
$198.79
Facility
Unavailable
$14.67 higher than Merced for the office setting.
California · 78428
Office
$230.91
Facility
Unavailable
$46.79 higher than Merced for the office setting.
California · 78428
Office
$230.83
Facility
Unavailable
$46.71 higher than Merced for the office setting.
California · 78428
Office
$236.05
Facility
Unavailable
$51.93 higher than Merced for the office setting.
California · 78428
Office
$235.73
Facility
Unavailable
$51.61 higher than Merced for the office setting.
California · 78428
Office
$190.28
Facility
Unavailable
$6.16 higher than Merced for the office setting.
California · 78428
Office
$201.27
Facility
Unavailable
$17.15 higher than Merced for the office setting.
California · 78428
Office
$194.42
Facility
Unavailable
$10.30 higher than Merced for the office setting.
California · 78428
Office
$203.36
Facility
Unavailable
$19.24 higher than Merced for the office setting.
California · 78428
Office
$184.12
Facility
Unavailable
The same base rate than Merced for the office setting.
California · 78428
Office
$216.91
Facility
Unavailable
$32.79 higher than Merced for the office setting.
California · 78428
Office
$184.12
Facility
Unavailable
The same base rate than Merced for the office setting.
California · 78428
Office
$184.12
Facility
Unavailable
The same base rate than Merced for the office setting.
District of Columbia · 78428
Office
$198.15
Facility
Unavailable
$14.03 higher than Merced for the office setting.
Florida · 78428
Office
$180.46
Facility
Unavailable
$3.66 lower than Merced for the office setting.
Illinois · 78428
Office
$174.93
Facility
Unavailable
$9.19 lower than Merced for the office setting.
New York · 78428
Office
$197.22
Facility
Unavailable
$13.10 higher than Merced for the office setting.
Alaska · 78428
Office
$191.97
Facility
Unavailable
$7.85 higher than Merced for the office setting.
Alabama · 78428
Office
$152.09
Facility
Unavailable
$32.03 lower than Merced for the office setting.
Arkansas · 78428
Office
$149.67
Facility
Unavailable
$34.45 lower than Merced for the office setting.
Arizona · 78428
Office
$166.23
Facility
Unavailable
$17.89 lower than Merced for the office setting.
Colorado · 78428
Office
$179.98
Facility
Unavailable
$4.14 lower than Merced for the office setting.
Connecticut · 78428
Office
$183.04
Facility
Unavailable
$1.08 lower than Merced for the office setting.
Delaware · 78428
Office
$169.18
Facility
Unavailable
$14.94 lower than Merced for the office setting.
Florida · 78428
Office
$174.76
Facility
Unavailable
$9.36 lower than Merced for the office setting.
Florida · 78428
Office
$165.88
Facility
Unavailable
$18.24 lower than Merced for the office setting.
Georgia · 78428
Office
$173.85
Facility
Unavailable
$10.27 lower than Merced for the office setting.
Georgia · 78428
Office
$155.99
Facility
Unavailable
$28.13 lower than Merced for the office setting.
Hawaii · 78428
Office
$189.66
Facility
Unavailable
$5.54 higher than Merced for the office setting.
Iowa · 78428
Office
$157.42
Facility
Unavailable
$26.70 lower than Merced for the office setting.
Idaho · 78428
Office
$158.32
Facility
Unavailable
$25.80 lower than Merced for the office setting.
Illinois · 78428
Office
$161.92
Facility
Unavailable
$22.20 lower than Merced for the office setting.
Illinois · 78428
Office
$159.86
Facility
Unavailable
$24.26 lower than Merced for the office setting.
Illinois · 78428
Office
$176.86
Facility
Unavailable
$7.26 lower than Merced for the office setting.
Indiana · 78428
Office
$159.35
Facility
Unavailable
$24.77 lower than Merced for the office setting.
Kansas · 78428
Office
$156.10
Facility
Unavailable
$28.02 lower than Merced for the office setting.
Kentucky · 78428
Office
$154.91
Facility
Unavailable
$29.21 lower than Merced for the office setting.
Louisiana · 78428
Office
$162.88
Facility
Unavailable
$21.24 lower than Merced for the office setting.
Louisiana · 78428
Office
$154.44
Facility
Unavailable
$29.68 lower than Merced for the office setting.
Massachusetts · 78428
Office
$199.59
Facility
Unavailable
$15.47 higher than Merced for the office setting.
Massachusetts · 78428
Office
$178.54
Facility
Unavailable
$5.58 lower than Merced for the office setting.
Maryland · 78428
Office
$182.43
Facility
Unavailable
$1.69 lower than Merced for the office setting.
Maryland · 78428
Office
$172.79
Facility
Unavailable
$11.33 lower than Merced for the office setting.
Maine · 78428
Office
$158.67
Facility
Unavailable
$25.45 lower than Merced for the office setting.
Maine · 78428
Office
$168.86
Facility
Unavailable
$15.26 lower than Merced for the office setting.
Michigan · 78428
Office
$167.60
Facility
Unavailable
$16.52 lower than Merced for the office setting.
Michigan · 78428
Office
$158.85
Facility
Unavailable
$25.27 lower than Merced for the office setting.
Minnesota · 78428
Office
$173.52
Facility
Unavailable
$10.60 lower than Merced for the office setting.
Missouri · 78428
Office
$162.22
Facility
Unavailable
$21.90 lower than Merced for the office setting.
Missouri · 78428
Office
$164.14
Facility
Unavailable
$19.98 lower than Merced for the office setting.
Missouri · 78428
Office
$151.18
Facility
Unavailable
$32.94 lower than Merced for the office setting.
Mississippi · 78428
Office
$150.49
Facility
Unavailable
$33.63 lower than Merced for the office setting.
Montana · 78428
Office
$171.01
Facility
Unavailable
$13.11 lower than Merced for the office setting.
North Carolina · 78428
Office
$160.57
Facility
Unavailable
$23.55 lower than Merced for the office setting.
North Dakota · 78428
Office
$169.62
Facility
Unavailable
$14.50 lower than Merced for the office setting.
Nebraska · 78428
Office
$158.53
Facility
Unavailable
$25.59 lower than Merced for the office setting.
New Hampshire · 78428
Office
$176.60
Facility
Unavailable
$7.52 lower than Merced for the office setting.
New Jersey · 78428
Office
$195.70
Facility
Unavailable
$11.58 higher than Merced for the office setting.
New Jersey · 78428
Office
$185.44
Facility
Unavailable
$1.32 higher than Merced for the office setting.
New Mexico · 78428
Office
$159.59
Facility
Unavailable
$24.53 lower than Merced for the office setting.
Nevada · 78428
Office
$170.77
Facility
Unavailable
$13.35 lower than Merced for the office setting.
New York · 78428
Office
$201.72
Facility
Unavailable
$17.60 higher than Merced for the office setting.
New York · 78428
Office
$186.26
Facility
Unavailable
$2.14 higher than Merced for the office setting.
New York · 78428
Office
$199.75
Facility
Unavailable
$15.63 higher than Merced for the office setting.
New York · 78428
Office
$163.15
Facility
Unavailable
$20.97 lower than Merced for the office setting.
Ohio · 78428
Office
$158.57
Facility
Unavailable
$25.55 lower than Merced for the office setting.
Oklahoma · 78428
Office
$155.16
Facility
Unavailable
$28.96 lower than Merced for the office setting.
Oregon · 78428
Office
$186.73
Facility
Unavailable
$2.61 higher than Merced for the office setting.
Oregon · 78428
Office
$169.75
Facility
Unavailable
$14.37 lower than Merced for the office setting.
Pennsylvania · 78428
Office
$177.80
Facility
Unavailable
$6.32 lower than Merced for the office setting.
Pennsylvania · 78428
Office
$159.13
Facility
Unavailable
$24.99 lower than Merced for the office setting.
Puerto Rico · 78428
Office
$172.55
Facility
Unavailable
$11.57 lower than Merced for the office setting.
Rhode Island · 78428
Office
$175.97
Facility
Unavailable
$8.15 lower than Merced for the office setting.
South Carolina · 78428
Office
$159.77
Facility
Unavailable
$24.35 lower than Merced for the office setting.
South Dakota · 78428
Office
$169.46
Facility
Unavailable
$14.66 lower than Merced for the office setting.
Tennessee · 78428
Office
$156.89
Facility
Unavailable
$27.23 lower than Merced for the office setting.
Texas · 78428
Office
$179.11
Facility
Unavailable
$5.01 lower than Merced for the office setting.
Texas · 78428
Office
$157.95
Facility
Unavailable
$26.17 lower than Merced for the office setting.
Texas · 78428
Office
$169.41
Facility
Unavailable
$14.71 lower than Merced for the office setting.
Texas · 78428
Office
$170.34
Facility
Unavailable
$13.78 lower than Merced for the office setting.
Texas · 78428
Office
$168.93
Facility
Unavailable
$15.19 lower than Merced for the office setting.
Texas · 78428
Office
$169.81
Facility
Unavailable
$14.31 lower than Merced for the office setting.
Texas · 78428
Office
$171.09
Facility
Unavailable
$13.03 lower than Merced for the office setting.
Texas · 78428
Office
$163.48
Facility
Unavailable
$20.64 lower than Merced for the office setting.
Utah · 78428
Office
$162.18
Facility
Unavailable
$21.94 lower than Merced for the office setting.
Virginia · 78428
Office
$167.89
Facility
Unavailable
$16.23 lower than Merced for the office setting.
United States Virgin Islands · 78428
Office
$172.55
Facility
Unavailable
$11.57 lower than Merced for the office setting.
Vermont · 78428
Office
$168.42
Facility
Unavailable
$15.70 lower than Merced for the office setting.
Washington · 78428
Office
$178.38
Facility
Unavailable
$5.74 lower than Merced for the office setting.
Washington · 78428
Office
$204.38
Facility
Unavailable
$20.26 higher than Merced for the office setting.
Wisconsin · 78428
Office
$163.38
Facility
Unavailable
$20.74 lower than Merced for the office setting.
West Virginia · 78428
Office
$153.25
Facility
Unavailable
$30.87 lower than Merced for the office setting.
Wyoming · 78428
Office
$170.40
Facility
Unavailable
$13.72 lower than Merced for the office setting.
78428 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
$149.67
$210.09
Color shows the midpoint of each state’s locality range.
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $191.97 | 1 |
| AL | $152.09 | 1 |
| AR | $149.67 | 1 |
| AZ | $166.23 | 1 |
| CA | $184.12–$236.05 | 29 |
| CO | $179.98 | 1 |
| CT | $183.04 | 1 |
| DC | $198.15 | 1 |
| DE | $169.18 | 1 |
| FL | $165.88–$180.46 | 3 |
| GA | $155.99–$173.85 | 2 |
| GU | $189.66 | 1 |
| HI | $189.66 | 1 |
| IA | $157.42 | 1 |
| ID | $158.32 | 1 |
| IL | $159.86–$176.86 | 4 |
| IN | $159.35 | 1 |
| KS | $156.10 | 1 |
| KY | $154.91 | 1 |
| LA | $154.44–$162.88 | 2 |
| MA | $178.54–$199.59 | 2 |
| MD | $172.79–$198.15 | 3 |
| ME | $158.67–$168.86 | 2 |
| MI | $158.85–$167.60 | 2 |
| MN | $173.52 | 1 |
| MO | $151.18–$164.14 | 3 |
| MS | $150.49 | 1 |
| MT | $171.01 | 1 |
| NC | $160.57 | 1 |
| ND | $169.62 | 1 |
| NE | $158.53 | 1 |
| NH | $176.60 | 1 |
| NJ | $185.44–$195.70 | 2 |
| NM | $159.59 | 1 |
| NV | $170.77 | 1 |
| NY | $163.15–$201.72 | 5 |
| OH | $158.57 | 1 |
| OK | $155.16 | 1 |
| OR | $169.75–$186.73 | 2 |
| PA | $159.13–$177.80 | 2 |
| PR | $172.55 | 1 |
| RI | $175.97 | 1 |
| SC | $159.77 | 1 |
| SD | $169.46 | 1 |
| TN | $156.89 | 1 |
| TX | $157.95–$179.11 | 8 |
| UT | $162.18 | 1 |
| VA | $167.89–$198.15 | 2 |
| VI | $172.55 | 1 |
| VT | $168.42 | 1 |
| WA | $178.38–$204.38 | 2 |
| WI | $163.38 | 1 |
| WV | $153.25 | 1 |
| WY | $170.40 | 1 |
Merced is a Medicare payment area. Our Census mapping connects it to 24 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
Turn a percentage into dollars for 78428 in Merced. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$202.53
$184.12 × 110% = $202.53
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 78428 in Merced.
PPRRVU2026_Oct_nonQPP.csv
9,341
GPCI2026.csv
15
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.76 | × 1.017 | 0.7729 |
| Practice expense | 4.29 | × 1.096 | 4.7018 |
| Malpractice | 0.07 | × 0.536 | 0.0375 |
| Total RVUs | 5.5123 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Merced$184.12
Open 78428 in the RVU calculator →
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.76 | 1.017 |
| Practice expense | 4.29 | 1.096 |
| Malpractice | 0.07 | 0.536 |
(0.76 × 1.017 + 4.29 × 1.096 + 0.07 × 0.536) × $33.4009 = $184.12
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
78428 · Office / nonfacility
$184.12
Effective 2026-10-01
The base rate is $6.30 higher than on 2025-10-01, moving from $177.82 to $184.12 (3.5%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
January 1, 2026
RVU26A
$177.82changed to$184.12
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
Earliest loaded release: $177.82
Held through RVU25B, RVU25C, RVU25D.
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $184.12 | Not available in this setting | RVU26D |
| 2026-07-01 | $184.12 | Not available in this setting | RVU26C |
| 2026-04-01 | $184.12 | Not available in this setting | RVU26B |
| 2026-01-01 | $184.12 | Not available in this setting | RVU26A |
| 2025-10-01 | $177.82 | Not available in this setting | RVU25D |
| 2025-07-01 | $177.82 | Not available in this setting | RVU25C |
| 2025-04-01 | $177.82 | Not available in this setting | RVU25B |
| 2025-01-01 | $177.82 | Not available in this setting | RVU25A |
Use 78428 when the study is intended to detect and quantify a cardiac shunt. A study focused on cardiac function rather than shunt quantification may point to a different code, such as 78414.
Yes. Report modifier 26 for the interpretation and modifier TC for the equipment and staff service; billing without either modifier represents the global service.
It applies to the technical component. It does not reduce the professional component under the CMS rule provided for this code.
Document the clinical reason for evaluating a shunt, the study performed, the quantitative results, and the physician’s interpretation. The record should make clear that shunt detection or measurement was the purpose.
Report the completed shunt study, not separate units for individual images. The code covers shunt detection with or without imaging.
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.