Billing code 78428: Shunt imagingMedicare rate & RVUs in Colorado
Nuclear medicine testing that detects and quantifies abnormal blood flow between cardiac circulations, reported when the clinical question is a suspected cardiac shunt.
Medicare pays $179.98 for 78428 in the office in Colorado (Colorado). Which amount applies depends on the service address.
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 9 sections
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.
78428 in Colorado
| Payment locality | Office | Facility |
|---|---|---|
| Colorado | $179.98 | Unavailable |
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.
How the rate is built · 78428
RVUs × geographic indexes × conversion factor
Work0.76
0.76 RVUs× 1.000 GPCI
Practice expense4.29
4.29 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
5.1200
Conversion factor
$33.4009
Medicare rate
$171.01
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 78428
The CMS indicators that decide how 78428 is paid alongside other services.
CMS payment indicators · 78428
Shunt 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
78428 without 26 · national office
$171.01
Shunt imaging
78428-26 · Professional component
$35.07
Pays only the interpretation and report.
78428 compared with similar codes
Compare codes · National
4 codes, side by side
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.
78428 billing questions
When should 78428 be chosen over a cardiac function study?
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.
Can the professional and technical services be billed separately?
Yes. Report modifier 26 for the interpretation and modifier TC for the equipment and staff service; billing without either modifier represents the global service.
What does the cardiovascular diagnostic multiple-procedure reduction affect?
It applies to the technical component. It does not reduce the professional component under the CMS rule provided for this code.
What documentation supports reporting 78428?
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.
How should the study be counted for reporting?
Report the completed shunt study, not separate units for individual images. The code covers shunt detection with or without imaging.
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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