Billing code 78468: Cardiac infarct imagingMedicare rate & RVUs in Rhode Island
Planar infarct-avid myocardial imaging with ejection fraction is reported when a nuclear cardiac study evaluates infarct-related uptake and ventricular function.
Medicare pays $188.38 for 78468 in the office in Rhode Island (Rhode Island). 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 78468 covers
This nuclear medicine cardiac study uses planar images to assess infarct-avid myocardial uptake and includes measurement of the heart’s ejection fraction. It is performed in a nuclear medicine department or imaging center, with the images and findings interpreted by a qualified physician, commonly a nuclear medicine physician or cardiologist. The study addresses a different imaging question from myocardial perfusion imaging, which evaluates blood flow to the heart muscle.
Report 78468 when the service includes both infarct-avid planar imaging and ejection-fraction assessment; documentation should support the imaging performed and the reported functional result. The service may be billed globally, or the interpretation may be reported with modifier 26 and the equipment and staff portion with modifier TC. When multiple cardiovascular diagnostic procedures are reported, the CMS multiple-procedure reduction applies to the technical component.
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.
78468 in Rhode Island
| Payment locality | Office | Facility |
|---|---|---|
| Rhode Island | $188.38 | Unavailable |
How the 78468 rate is calculated
Each of 78468’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 · 78468
RVUs × geographic indexes × conversion factor
Work0.78
0.78 RVUs× 1.000 GPCI
Practice expense4.63
4.63 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
5.4800
Conversion factor
$33.4009
Medicare rate
$183.04
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 78468
The CMS indicators that decide how 78468 is paid alongside other services.
CMS payment indicators · 78468
Cardiac 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
78468 without 26 · national office
$183.04
Cardiac infarct imaging
78468-26 · Professional component
$36.74
Pays only the interpretation and report.
78468 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 78466Infarct imaging
- Both describe infarct-avid planar myocardial imaging, but 78468 includes ejection-fraction assessment. Report 78466 when that assessment is not part of the service.
- 78469Infarct imaging
- 78469 uses SPECT for infarct-avid imaging; 78468 is the planar study that includes ejection-fraction assessment.
- 78472Cardiac blood-pool imaging
- 78472 is a gated blood-pool study used to evaluate cardiac function. It does not represent infarct-avid myocardial imaging.
- 78452Nuclear stress test
- 78452 reports multiple-study SPECT myocardial perfusion imaging, while 78468 concerns infarct-avid planar imaging with ejection-fraction assessment.
78468 billing questions
How does 78468 differ from 78466?
78468 includes ejection-fraction assessment with the infarct-avid planar imaging. Use 78466 when that imaging is performed without the ejection-fraction component.
When is 78469 a better match?
78469 describes infarct-avid myocardial imaging using SPECT, a tomographic technique. Code 78468 is the planar study with ejection-fraction assessment.
Can the professional and technical services be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service. Without either modifier, the claim represents the global service.
Does the multiple-procedure reduction affect both components?
The CMS cardiovascular diagnostic multiple-procedure reduction applies to the technical component. It does not apply to the professional component under the rule supplied for this code.
What documentation supports reporting 78468?
The record should identify the infarct-avid planar imaging performed and support the ejection-fraction assessment. A perfusion study or a blood-pool function study alone does not establish the service represented by 78468.
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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