CPT 78458Radiology

Ven thrombosis images bilat

CPT code 78458 covers bilateral venous thrombosis imaging, a nuclear medicine test that creates pictures of veins in both legs to detect blood clots. This diagnostic procedure uses radioactive tracers to visualize the deep veins and identify potentially dangerous blockages.

Showing rates for

National Average

Base Medicare rate

$184.70

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

0.9

PE RVU (NF)

4.73

MP RVU

0.08

Total RVU

5.71

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Always verify bilateral documentation in radiology report before billing 78458; if only one leg was imaged, use appropriate unilateral code instead
Impact: Prevents denials and recoupment; bilateral code pays same $184.70 as unilateral, so incorrect coding doesn't increase payment but risks audit flags
Bill global code 78458 in freestanding facilities; use modifier 26 or TC only when professional and technical components are split between providers
Impact: Facility and non-facility rates are identical at $184.70, but incorrect modifier use can reduce payment by 30-70%
Document radiopharmaceutical type, dose, route, and time of administration in medical record to satisfy nuclear medicine billing requirements
Impact: Missing radiopharmaceutical documentation is top audit trigger for nuclear medicine codes; can result in complete claim denial
Ensure diagnosis code clearly supports medical necessity for bilateral study (e.g., bilateral symptoms or high-risk bilateral assessment)
Impact: Unilateral symptom codes with bilateral procedure codes trigger automatic medical necessity denials in many payer systems
Do not separately bill radiopharmaceutical supply codes; these are included in the 78458 reimbursement
Impact: Attempting to bill supplies separately results in denials and potential unbundling allegations
Verify that ultrasound or other venous imaging wasn't already performed same day; many payers require ultrasound as first-line before authorizing nuclear medicine studies
Impact: Failure to follow payer-specific imaging pathways can result in complete denial of $184.70 claim

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 78458?

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 78458 in 2025?

The 2025 Medicare national average reimbursement for CPT 78458 is $184.70 for both facility and non-facility settings. This rate is calculated using 5.71 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Does CPT 78458 include both legs or just one?

CPT 78458 specifically describes bilateral venous thrombosis imaging, meaning both legs are included in the code. If only one leg is imaged, a different unilateral code should be used instead. You cannot bill 78458 twice for bilateral imaging.

Can I bill CPT 78458 with a venous duplex ultrasound on the same day?

Billing 78458 with venous ultrasound on the same day often results in denials due to duplication of diagnostic services. Nuclear medicine venography is typically reserved for cases where ultrasound is inconclusive or contraindicated. If both are medically necessary, extensive documentation is required and modifier 59 may be needed.

What modifiers are commonly used with CPT 78458?

Common modifiers for 78458 include modifier 26 (professional component only), TC (technical component only), 52 (reduced service for incomplete studies), and 59 (distinct procedural service when billed with other imaging). Global billing without modifiers is appropriate when one entity provides both technical and professional services.

How many RVUs is CPT code 78458 worth in 2025?

CPT 78458 has a total of 5.71 RVUs in 2025, consisting of 0.9 work RVUs, 4.73 practice expense RVUs, and 0.08 malpractice RVUs. The facility and non-facility PE RVUs are identical at 4.73.

What documentation is required to bill CPT 78458?

Required documentation includes clinical indication for bilateral study, radiopharmaceutical type and dose, administration details, imaging protocol, bilateral findings documented separately for each leg, complete physician interpretation, and medical necessity justification. Missing radiopharmaceutical documentation is the most common audit trigger.

Is prior authorization required for CPT 78458?

Prior authorization requirements vary by payer, but many commercial insurers and Medicare Advantage plans require prior authorization for nuclear medicine venography (CPT 78458) as it is not typically a first-line imaging study for DVT. Most payers require documentation that venous duplex ultrasound was attempted first or is contraindicated.