Billing code 78496: Cardiac blood poolMedicare rate & RVUs in Ohio
Reports supplemental first-pass cardiac blood-pool imaging used with a primary study to assess ventricular function, wall motion, and ejection fraction.
Medicare pays $40.25 for 78496 in the office in Ohio (Ohio). 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 78496 covers
This add-on represents supplemental imaging performed with a first-pass cardiac blood-pool study. The study follows a radiotracer bolus as it passes through the heart, allowing assessment of ventricular function, wall motion, and ejection fraction. Nuclear medicine physicians, radiologists, or cardiologists typically interpret the diagnostic images; nuclear medicine staff operate the imaging equipment in hospital or outpatient settings.
Report 78496 only with its eligible primary cardiac blood-pool procedure, such as a first-pass study, and document the additional imaging and its relationship to that study. CMS treats it as an add-on paid within the primary procedure's global period. The diagnostic service may be billed globally, or divided between the professional interpretation with modifier 26 and the technical service with modifier TC. Documentation should identify the first-pass study, the supplemental imaging performed, and the interpretation; do not report 78496 as a stand-alone service.
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.
78496 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $40.25 | Unavailable |
How the 78496 rate is calculated
Each of 78496’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 · 78496
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.49Practice expense 0.75Malpractice 0.03
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 78496
The CMS indicators that decide how 78496 is paid alongside other services.
CMS payment indicators · 78496
Cardiac blood pool
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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
78496 without 26 · national office
$42.42
Cardiac blood pool
78496-26 · Professional component
$23.05
Pays only the interpretation and report.
78496 compared with similar codes
Compare codes
78496 vs 78481 vs 78483 vs 78494: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 78481Cardiac function imaging
- 78481 reports the primary single-study first-pass cardiac blood-pool service; 78496 is supplemental and cannot replace that primary code.
- 78483First-pass cardiac imaging
- 78483 reports the primary multiple-study first-pass service. Use 78496 only when the supplemental imaging is performed with an eligible primary procedure.
- 78494Cardiac blood-pool imaging
- 78494 is a gated-equilibrium cardiac blood-pool study. 78496 is an add-on associated with a primary study, rather than a stand-alone equilibrium study.
78496 billing questions
Can 78496 be billed by itself?
No. It is an add-on and must be reported with an eligible primary cardiac blood-pool procedure, such as 78481 or 78483.
How does 78496 differ from 78481?
78481 reports the primary first-pass cardiac blood-pool study. 78496 reports supplemental imaging performed with an eligible primary study.
Which modifiers identify the professional and technical services?
Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service. Without either modifier, the claim represents the global service.
What documentation supports reporting 78496?
Document the primary first-pass study, the supplemental imaging performed, and the diagnostic interpretation. The record should support reporting the add-on with the primary procedure.
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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