Billing code 78469: Infarct imagingMedicare rate & RVUs in Maine
Tomographic myocardial infarct imaging uses SPECT to localize infarct-related tracer uptake when a clinician needs a nuclear medicine assessment of myocardial injury.
Medicare pays $189.05–$201.22 for 78469 in the office in Maine, from Rest Of Maine to Southern Maine. 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 78469 covers
This study uses a radiotracer and tomographic single-photon emission computed tomography (SPECT) images to show the distribution and location of uptake associated with myocardial infarction. It is performed in a nuclear medicine department or imaging center, commonly with interpretation by a nuclear medicine physician, cardiologist, or radiologist. The clinical question is infarct-related uptake, rather than stress-induced ischemia or routine myocardial perfusion assessment.
Select this code when the documented study is tomographic infarct imaging; planar infarct imaging is represented by related codes 78466 and 78468. The report should support the imaging method and interpretation, with the order or clinical record establishing the reason for the study. CMS recognizes professional and technical components: modifier 26 identifies interpretation, modifier TC identifies equipment and staff, and reporting without either modifier represents the global service. The cardiovascular diagnostic multiple procedure reduction applies to the technical component when applicable.
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 78469 pays more and less in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Maine | $189.05 | Unavailable |
| Southern Maine | $201.22 | Unavailable |
How the 78469 rate is calculated
Each of 78469’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 · 78469
RVUs × geographic indexes × conversion factor
Work0.90
0.90 RVUs× 1.000 GPCI
Practice expense5.12
5.12 RVUs× 1.000 GPCI
Malpractice0.08
0.08 RVUs× 1.000 GPCI
Adjusted RVUs
6.1000
Conversion factor
$33.4009
Medicare rate
$203.75
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 78469
The CMS indicators that decide how 78469 is paid alongside other services.
CMS payment indicators · 78469
Infarct 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
78469 without 26 · national office
$203.75
Infarct imaging
78469-26 · Professional component
$42.42
Pays only the interpretation and report.
78469 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 78466Infarct imaging
- Both codes concern myocardial infarct imaging. Choose 78469 for tomographic SPECT images and 78466 for planar imaging.
- 78468Cardiac infarct imaging
- Code 78468 is the planar infarct imaging option associated with ejection fraction assessment; 78469 is the tomographic SPECT option.
- 78451Cardiac SPECT
- Code 78451 reports a single-study myocardial perfusion SPECT examination. It evaluates myocardial perfusion rather than infarct-related tracer uptake.
- 78452Nuclear stress test
- Code 78452 is for multiple-study myocardial perfusion SPECT, commonly rest and stress imaging; 78469 is for tomographic infarct imaging.
78469 billing questions
How does this differ from code 78466?
Code 78469 represents tomographic SPECT infarct imaging. Code 78466 is for the planar form of infarct imaging.
How does this differ from code 78468?
Code 78468 is the planar infarct imaging option associated with ejection fraction assessment. Use 78469 for the tomographic SPECT infarct study.
When should modifier 26 or TC be reported?
Use modifier 26 for the physician’s interpretation and report, or TC for the technical service, including equipment and staff. Without either modifier, the claim represents the global service.
Does the multiple procedure reduction affect the interpretation?
The CMS cardiovascular diagnostic multiple procedure reduction applies to the technical component. It does not describe a reduction to the professional component.
Can this code be used for a myocardial perfusion SPECT study?
No. Code 78469 describes infarct imaging; myocardial perfusion SPECT studies are represented by codes such as 78451 or 78452, depending on the study performed.
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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