CPT 78457Radiology

Venous thrombosis imaging

CPT 78457 covers nuclear medicine imaging to detect blood clots in veins, typically using radioactive tracers to visualize where clots may be blocking blood flow in the legs or other areas.

Showing rates for

National Average

Base Medicare rate

$151.38

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

0.77

PE RVU (NF)

3.74

MP RVU

0.17

Total RVU

4.68

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

NCCI bundling edits

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Billing tips

Verify that ultrasound was attempted or contraindicated before ordering nuclear medicine venous imaging, as most payers require ultrasound as first-line imaging
Impact: Prevents medical necessity denials which constitute 40-50% of 78457 claim rejections
Document the specific radiopharmaceutical used (e.g., Tc-99m labeled agent) and dosage in the medical record, as some payers separately reimburse radiopharmaceuticals
Impact: May allow additional reimbursement of $50-150 for radiopharmaceutical supply depending on payer contract
Bill technical and professional components separately when services are split between facility and interpreting physician to maximize reimbursement
Impact: Ensures proper payment allocation; prevents leaving approximately $60-90 unreimbursed when components split
Link appropriate ICD-10 codes for DVT symptoms (R22.41-R22.43 for localized swelling) or risk factors (Z86.718 for personal history of PE/DVT) to establish medical necessity
Impact: Reduces denial rate by 30-35% by demonstrating clear clinical indication
Do not bill 78457 on the same day as venous Doppler ultrasound (93970-93971) without modifier 59 and strong documentation of why both studies were necessary
Impact: Prevents bundling denials and potential audit flags for duplicate imaging worth $151.38
Ensure interpretation report includes comparison to any prior studies, description of tracer distribution pattern, and specific anatomic location of any identified thrombus
Impact: Meets documentation requirements for payment and reduces audit risk by 40-50%

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78457 in 2025?

The 2025 Medicare national average reimbursement for CPT 78457 is $151.38 for both facility and non-facility settings. This is based on 4.68 total RVUs multiplied by the 2025 conversion factor of 32.3465.

How many RVUs is CPT code 78457 worth?

CPT 78457 is valued at 4.68 total RVUs for 2025, broken down as 0.77 work RVU, 3.74 practice expense RVU, and 0.17 malpractice RVU.

Can you bill CPT 78457 and venous Doppler ultrasound on the same day?

Billing both 78457 and venous Doppler (93970-93971) on the same day typically requires modifier 59 and strong documentation explaining why both studies were medically necessary. Most payers consider ultrasound first-line and may deny 78457 as duplicate unless ultrasound was inconclusive or inadequate.

What diagnosis codes support medical necessity for CPT 78457?

Common supporting diagnosis codes include I82.40-I82.4Z9 (acute DVT codes), R22.41-R22.43 (localized swelling of limb), I80.1-I80.3 (phlebitis and thrombophlebitis), and Z86.718 (personal history of VTE). Always document clinical suspicion and why the study is necessary.

Is CPT 78457 still widely used for DVT diagnosis?

CPT 78457 utilization has declined significantly as venous Doppler ultrasound has become the first-line imaging modality for DVT. It is now primarily used in select cases where ultrasound is inconclusive, technically limited, or when evaluating pelvic/abdominal veins not well visualized by ultrasound.

Do I need modifier 26 or TC when billing CPT 78457?

Use modifier 26 when billing only the professional component (physician interpretation), modifier TC for only the technical component (equipment and supplies), or no modifier for global billing when the same entity provides both components. Split billing is common between hospitals (TC) and reading physicians (26).

What are the documentation requirements to bill CPT 78457?

Required documentation includes a physician order with clinical indication, radiopharmaceutical details (type, dose, administration), imaging protocol, complete interpretation report by qualified nuclear medicine physician or radiologist describing tracer distribution and venous anatomy evaluated, and specific findings regarding presence or absence of thrombosis.