CPT 78456Radiology

Acute venous thrombus image

CPT code 78456 is used for nuclear medicine imaging that helps detect fresh blood clots in veins, typically in the legs or pelvis. This specialized scan uses radioactive tracers to identify potentially dangerous clots that could travel to the lungs.

Showing rates for

National Average

Base Medicare rate

$272.68

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

PE RVU (NF)

7.35

MP RVU

0.08

Total RVU

8.43

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

NCCI bundling edits

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Billing tips

Always verify that radiotracer administration is documented separately if billing for the radiopharmaceutical supply (A9500-A9700 series codes) in addition to 78456
Impact: Can add $150-$400 in additional reimbursement for the radiopharmaceutical itself, which is separately billable from the imaging procedure
Document the specific clinical indication explaining why nuclear medicine imaging was chosen over conventional ultrasound or CT venography to support medical necessity
Impact: Prevents denials for lack of medical necessity; documentation should reference failed/inconclusive prior studies or contraindications to other modalities
Split-bill professional and technical components correctly based on practice setting - hospital-employed physicians should use no modifier (global), while independent interpreters use modifier 26
Impact: Incorrect modifier usage can result in 50-100% payment reduction or overpayment recoupment during audits
Code bilateral venous studies as a single unit of 78456 unless payer-specific guidance indicates otherwise; do not use modifier 50 or bill twice
Impact: Prevents $272.68 overpayment and subsequent recoupment; CPT code descriptor includes bilateral imaging in single code
Ensure interpretation report specifically addresses acute versus chronic thrombus characteristics and specifies anatomic locations with laterality
Impact: Meets documentation requirements for medical necessity and supports proper ICD-10 coding (I82.4x series) which affects payment bundling
Check place of service codes carefully - use POS 22 for hospital outpatient, POS 21 for inpatient; this affects whether facility or non-facility rate applies

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78456 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78456 is $272.68 for both facility and non-facility settings. This is based on 8.43 total RVUs (1.0 work RVU, 7.35 PE RVU, 0.08 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 78456 be billed with venous duplex ultrasound on the same day?

Yes, but it requires appropriate modifier usage (typically modifier 59 on 78456) and clear documentation showing medical necessity for both procedures. The nuclear medicine study is typically performed when ultrasound results are inconclusive or when assessing venous regions not well-visualized by ultrasound. Without proper modifier and documentation, the claim will likely be denied as a duplicate service.

How many RVUs is CPT code 78456 worth in 2025?

CPT 78456 has 8.43 total RVUs in 2025, consisting of 1.0 work RVU, 7.35 practice expense RVU (both facility and non-facility), and 0.08 malpractice RVU according to the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

What modifiers are most commonly used with CPT 78456?

The most common modifiers for 78456 are modifier 26 (professional component only when interpretation is billed separately), modifier TC (technical component only when facility bills equipment/technologist services), and modifier 59 (distinct procedural service when performed with other imaging on the same day). Modifier selection depends on practice setting and whether other procedures are performed.

Is CPT 78456 covered by Medicare for DVT diagnosis?

Medicare covers CPT 78456 when medically necessary for acute venous thrombosis detection, but typically requires documentation that less invasive or less expensive imaging (like ultrasound) was inconclusive, contraindicated, or clinically inappropriate as a first-line study. Local Coverage Determinations (LCDs) may specify additional coverage criteria, so verify your MAC's specific policy.

Do I bill CPT 78456 bilaterally with modifier 50?

No, CPT 78456 should not be billed with modifier 50 or reported twice for bilateral studies. The code descriptor encompasses imaging of the venous system which typically includes bilateral assessment as part of the standard procedure. Billing bilaterally would be considered incorrect coding and could result in overpayment recoupment.

What diagnosis codes support medical necessity for CPT 78456?

Common supporting diagnosis codes include I82.40-I82.4Z series (acute embolism and thrombosis of deep veins of lower extremity), I82.62-I82.623 (acute embolism of superior/inferior vena cava), I82.A1-I82.A3 (acute embolism of axillary/subclavian veins), and symptoms like R60.0 (localized edema) or R22.4 (localized swelling of lower limb) when thrombosis is suspected but not confirmed. Pre-authorization may be required depending on payer.