Billing code 78458: Venous imagingMedicare rate & RVUs in Nevada
Bilateral venous thrombosis imaging evaluates venous flow and possible thrombus in both sides when a nuclear medicine study is performed.
Medicare pays $185.69 for 78458 in the office in Nevada (Nevada**). 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 78458 covers
This nuclear medicine study images venous flow and possible thrombus on both sides, commonly in the lower extremities when bilateral venous thrombosis is being evaluated. A nuclear medicine or radiology physician interprets the images; the technical service involves the equipment and staff used to perform the study. The report should identify the areas examined and document the interpretation of the bilateral findings.
Report 78458 when the service performed is bilateral venous thrombosis imaging, rather than a single-side study. The code is already priced as bilateral, so modifier 50 does not increase payment. Bill the global service without a component modifier, or separate the interpretation with modifier 26 and the technical service with modifier TC. When the cardiovascular diagnostic multiple procedure reduction applies, it affects the technical component. Documentation should support that both sides were imaged and include the interpreting physician’s findings.
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.
78458 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | $185.69 | Unavailable |
How the 78458 rate is calculated
Each of 78458’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 · 78458
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.88Practice expense 4.60Malpractice 0.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78458
The CMS indicators that decide how 78458 is paid alongside other services.
CMS payment indicators · 78458
Venous 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) | 2 | Already bilateral by definition: paid once at 100%. |
| 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
78458 without 26 · national office
$186.04
Venous imaging
78458-26 · Professional component
$41.75
Pays only the interpretation and report.
78458 compared with similar codes
Compare codes
78458 vs 78457 vs 78456 vs 93970: national Medicare rates
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How to choose
- 78457Venous imaging
- 78457 represents a single-side venous thrombosis imaging study; 78458 represents bilateral imaging and is priced accordingly.
- 78456Venous thrombosis imaging
- 78456 is identified for acute venous thrombus imaging. Select 78458 when the documented service is bilateral venous thrombosis imaging.
- 93970Venous duplex scan
- 93970 reports bilateral extremity venous duplex ultrasound, not nuclear medicine venous thrombosis imaging.
78458 billing questions
When should 78458 be chosen over 78457?
Use 78458 for a bilateral venous thrombosis imaging study. Use 78457 when the study is for a single side.
Should modifier 50 be appended for a bilateral study?
No. 78458 is priced as bilateral, and modifier 50 does not increase payment.
Can the interpretation and technical service be billed separately?
Yes. Report modifier 26 for the professional interpretation or modifier TC for the technical service. Without either modifier, the claim represents the global service.
Which part of the service is subject to the multiple procedure reduction?
The cardiovascular diagnostic multiple procedure reduction applies to the technical component. It does not change the component designation of the professional interpretation.
What documentation supports reporting 78458?
Document that the bilateral study was performed, which areas were imaged, and the interpreting physician’s findings. The record should support bilateral rather than single-side 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
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