78414
No office rateNon-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.
On this page
CMS RVU26D · Effective 2026-10-01
78428 Shunt imaging Medicare reimbursement rates in Idaho
Nuclear medicine testing that detects and quantifies abnormal blood flow between cardiac circulations, reported when the clinical question is a suspected cardiac shunt. Compare 78428 office and facility rates across CMS payment localities in Idaho.
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.
What does Medicare pay for 78428 in Idaho?
Idaho has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$158.32
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Nuclear medicine
About 78428: Quantitative cardiac shunt imaging
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.
CMS billing rules for 78428
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
- Multiple procedures
- Cardiovascular diagnostic multiple procedure reduction applies to the technical component.
Where the value comes from
- Work RVU0.76 · 15%
- Practice expense (office) RVU4.29 · 84%
- Malpractice RVU0.07 · 1%
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.
78428 compared with similar codes
Office rates for Idaho, from the same CMS release.
$151.16
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.
$204.52
78483 describes multiple first-pass cardiac studies. Choose 78428 when the service is specifically a quantitative cardiac shunt study.
Compare 78428 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Idaho →
Office / nonfacility
$158.32
Facility
Unavailable
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How this local rate is calculated
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 Idaho.
PPRRVU2026_Oct_nonQPP.csv
9,341
- Code
- 78428
- Physician work
- 0.76
- Practice expense
- 4.29
- Malpractice
- 0.07
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.76 | × 1.000 | 0.7600 |
| Practice expense | 4.29 | × 0.920 | 3.9468 |
| Malpractice | 0.07 | × 0.473 | 0.0331 |
| Total RVUs | 4.7399 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$158.32
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.76 | 1 |
| Practice expense | 4.29 | 0.92 |
| Malpractice | 0.07 | 0.473 |
(0.76 × 1 + 4.29 × 0.92 + 0.07 × 0.473) × $33.4009 = $158.32
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 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 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.
9,33878414,,Non-imaging heart function,C,,0.00,0.00,,0.00,NA,0.00,0.00,0.00,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,33978414,26,Non-imaging heart function,A,,0.44,0.17,,0.17,,0.02,0.63,0.63,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,34078414,TC,Non-imaging heart function,C,,0.00,0.00,,0.00,NA,0.00,0.00,0.00,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,0.00,0.00,0.00
9,34178428,,Cardiac shunt imaging,A,,0.76,4.29,,4.29,NA,0.07,5.12,5.12,1,XXX,0.00,0.00,0.00,6,0,0,0,0,9,,33.4009,09,0,99,12.37,12.37,0.15
9,34278428,26,Cardiac shunt imaging,A,,0.76,0.26,,0.26,,0.03,1.05,1.05,1,XXX,0.00,0.00,0.00,6,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,34378428,TC,Cardiac shunt imaging,A,,0.00,4.03,,4.03,NA,0.04,4.07,4.07,1,XXX,0.00,0.00,0.00,6,0,0,0,0,9,,33.4009,01,0,99,12.11,12.11,0.12
9,34478429,,Myocrd img pet 1 std w/ct,C,,0.00,0.00,,0.00,NA,0.00,0.00,0.00,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,44.27,44.27,0.08
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772