Billing code 78494: Cardiac blood-pool imagingMedicare rate & RVUs in Illinois
Reports ECG-gated SPECT imaging of the cardiac blood pool to assess ventricular function and wall motion rather than myocardial perfusion.
Medicare pays $198.05–$218.26 for 78494 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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 78494 covers
This study uses a radiotracer in the circulating blood and ECG gating to create tomographic images of the heart across the cardiac cycle. It helps assess ventricular function and wall motion, including left ventricular function monitoring in patients receiving potentially cardiotoxic chemotherapy. Nuclear medicine physicians or other qualified imaging professionals typically perform and interpret the study in hospital or outpatient imaging settings. Unlike myocardial perfusion SPECT, it images the blood pool rather than tracer uptake in heart muscle.
Report 78494 when the documented acquisition is gated equilibrium cardiac blood-pool SPECT. The record should support the cardiac indication, the SPECT blood-pool technique, and the physician’s interpretation. The code has professional and technical components: modifier 26 identifies interpretation, modifier TC identifies equipment and staff, and no component modifier represents the global service. CMS applies the cardiovascular diagnostic multiple-procedure reduction to the technical component when the rule applies; it does not reduce the professional component under this rule.
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 78494 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$198.05 to $218.26
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $216.10 | Unavailable |
| East St. Louis | $200.59 | Unavailable |
| Rest Of Illinois | $198.05 | Unavailable |
| Suburban Chicago | $218.26 | Unavailable |
How the 78494 rate is calculated
Each of 78494’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 · 78494
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.16Practice expense 5.07Malpractice 0.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78494
The CMS indicators that decide how 78494 is paid alongside other services.
CMS payment indicators · 78494
Cardiac blood-pool 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
78494 without 26 · national office
$211.09
Cardiac blood-pool imaging
78494-26 · Professional component
$54.44
Pays only the interpretation and report.
78494 compared with similar codes
Compare codes
78494 vs 78472 vs 78481 vs 78451 vs 78452: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 78472Cardiac blood-pool imaging
- Choose 78494 for gated equilibrium cardiac blood-pool SPECT. Choose 78472 when the corresponding single-study acquisition is planar.
- 78481Cardiac function imaging
- 78481 describes first-pass blood-pool imaging. 78494 is for gated equilibrium blood-pool SPECT.
- 78451Cardiac SPECT
- 78451 evaluates myocardial perfusion with SPECT for a single study. 78494 images the cardiac blood pool to assess ventricular function and wall motion.
- 78452Nuclear stress test
- 78452 is multiple-study myocardial perfusion SPECT, not gated equilibrium blood-pool SPECT.
78494 billing questions
How does 78494 differ from 78472?
78494 is for gated equilibrium SPECT blood-pool imaging. 78472 is the planar version for a single study.
Is this a myocardial perfusion study?
No. It images the cardiac blood pool to evaluate ventricular function and wall motion. Codes 78451 and 78452 describe myocardial perfusion SPECT.
When should modifier 26 or TC be used?
Use modifier 26 for the physician’s interpretation and modifier TC for the technical service. Report without either modifier when billing the global service.
Which part is subject to the multiple-procedure reduction?
CMS applies the cardiovascular diagnostic multiple-procedure reduction to the technical component. The stated reduction rule does not apply to the professional component.
What documentation supports reporting 78494?
Document the indication, gated equilibrium blood-pool SPECT technique, and interpretation. The record should distinguish this acquisition from planar or first-pass 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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