CPT 78291Radiology

Leveen/shunt patency exam

CPT 78291 is a nuclear medicine test that checks whether a LeVeen shunt (a tube that drains fluid from the abdomen into the bloodstream) is working properly. The test uses radioactive tracers to track fluid movement through the shunt.

Showing rates for

National Average

Base Medicare rate

$230.95

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.88

PE RVU (NF)

6.18

MP RVU

0.08

Total RVU

7.14

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify the LeVeen shunt placement is documented in the medical record before performing the study
Impact: Prevents denials for services performed on patients without documented shunts, which account for approximately 15% of claim rejections
Document specific clinical indicators of shunt malfunction (recurrent ascites, abdominal girth increase, inadequate drainage) to establish medical necessity
Impact: Strengthens medical necessity justification and reduces denial risk by approximately 25-30%
Bill the complete procedure code 78291 rather than attempting to bill component codes separately, as this is a comprehensive service
Impact: Ensures receipt of full $230.95 payment rather than reduced payments from unbundled component codes
Confirm the type of radiopharmaceutical used is documented, as Medicare may require this information for coverage determination
Impact: Prevents requests for additional documentation that delay payment by 30-45 days on average
When billing split/shared services in hospital settings, ensure clear documentation of which physician performed the supervision and interpretation
Impact: Prevents payment delays and ensures proper allocation between facility and professional components
Submit claims with diagnosis codes that specifically indicate the underlying condition causing ascites and the presence of the shunt device
Impact: Improves first-pass claim acceptance rate by approximately 20% compared to generic diagnosis coding

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 78291?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 78291 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78291 is $230.95 for both facility and non-facility settings. This rate is based on a total RVU of 7.14 multiplied by the 2025 conversion factor of 32.3465.

What is a LeVeen shunt patency examination?

A LeVeen shunt patency examination (CPT 78291) is a nuclear medicine imaging procedure that evaluates whether a peritoneovenous shunt is functioning properly. A radioactive tracer is injected into the peritoneal cavity, and sequential images track the flow through the shunt into the venous system to determine if the shunt is open and draining ascitic fluid appropriately.

How often can CPT 78291 be billed for the same patient?

There is no specific Medicare frequency limitation for CPT 78291, but medical necessity must be established for each examination. Repeated studies should be justified by documented clinical changes, new symptoms of shunt malfunction, or recurrent ascites despite previously patent shunt. Performing the study more frequently than every 3-6 months typically requires strong clinical justification.

What diagnosis codes support medical necessity for CPT 78291?

Common supporting diagnosis codes include K70.31 (alcoholic cirrhosis with ascites), K74.60 (unspecified cirrhosis with ascites), R18.8 (other ascites), C78.6 (malignant ascites), and T82.9 (complication of vascular prosthetic device). The diagnosis should reflect both the underlying condition causing ascites and the presence/complication of the shunt device.

Can CPT 78291 be billed with modifier 26 or TC?

Yes, CPT 78291 can be split into professional (modifier 26) and technical (modifier TC) components. This is common when a hospital or imaging center provides the equipment and radiopharmaceutical while an outside physician provides the interpretation, or vice versa. Each component should only be billed by the entity actually performing that portion of the service.

What are the work RVUs for CPT code 78291?

CPT 78291 has a work RVU of 0.88, practice expense RVU of 6.18 (both facility and non-facility), and malpractice RVU of 0.08, for a total RVU of 7.14 in 2025. The relatively high practice expense RVU reflects the cost of nuclear medicine equipment and radiopharmaceuticals.

What specialty physicians typically bill CPT 78291?

CPT 78291 is primarily billed by nuclear medicine physicians and radiologists with nuclear medicine privileges. Some interventional radiologists and gastroenterologists with appropriate nuclear medicine training and facility licensure may also perform and bill this procedure. The interpreting physician must have appropriate board certification or privileges in nuclear medicine.