CPT 78468Radiology

Heart infarct image (ef)

CPT code 78468 covers nuclear medicine imaging of the heart to assess damage from a heart attack and measure how well the heart pumps blood (ejection fraction). This diagnostic test uses radioactive tracers to visualize areas of dead or damaged heart tissue.

Showing rates for

National Average

Base Medicare rate

$175.96

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

0.8

PE RVU (NF)

4.57

MP RVU

0.07

Total RVU

5.44

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

NCCI bundling edits

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Billing tips

Document both infarct imaging interpretation AND ejection fraction calculation in the report to justify full code reimbursement
Impact: Missing ejection fraction documentation can trigger downcoding to 78466, resulting in $20-30 payment reduction
Bill separately for radiopharmaceutical (A9500-A9699 codes) as this is not included in 78468 reimbursement
Impact: Radiopharmaceutical can add $100-300 to total reimbursement depending on agent used
Verify facility vs non-facility status as both rates are identical at $175.96 for 2025, simplifying place-of-service coding
Impact: Eliminates payment differential concerns between settings for this code
Use modifier 26 or TC appropriately when splitting professional and technical components between providers
Impact: Improper global billing when components are split can result in 100% denial and recoupment
Include all gating and processing documentation when ejection fraction is calculated from gated acquisition
Impact: Supports medical necessity and prevents downcoding challenges worth approximately $25-35
Check NCCI edits before billing with stress testing codes on the same date of service
Impact: Bundling violations can result in denial of the add-on service, typically $150-400 in lost revenue

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78468 in 2025?

The 2025 Medicare national average payment for CPT 78468 is $175.96 for both facility and non-facility settings. This rate is based on 5.44 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Does CPT 78468 include the cost of the radiotracer?

No, CPT 78468 does not include the radiopharmaceutical cost. The radiotracer must be billed separately using HCPCS codes A9500-A9699 depending on the specific agent used (such as Tc-99m sestamibi or tetrofosmin).

What is the difference between CPT 78468 and 78466?

CPT 78468 includes both myocardial infarct imaging AND ejection fraction calculation, while 78466 is for infarct imaging only without ejection fraction. Code 78468 requires documentation of both components to justify the higher reimbursement.

Can CPT 78468 be billed with cardiac stress testing codes?

Yes, but careful attention to NCCI edits is required. When stress and rest imaging are performed as part of the same study, stress testing professional services may be separately reportable. Verify current bundling rules and use appropriate modifiers when necessary to prevent denials.

How many RVUs is CPT code 78468 worth in 2025?

CPT 78468 has 5.44 total RVUs in 2025, consisting of 0.8 work RVUs, 4.57 practice expense RVUs, and 0.07 malpractice RVUs. Both facility and non-facility PE RVUs are identical at 4.57.

What medical specialties typically bill CPT 78468?

CPT 78468 is primarily billed by cardiologists with nuclear cardiology certification, nuclear medicine physicians, and radiologists. The interpreting physician must have appropriate board certification and the procedure must be performed by certified nuclear medicine technologists.

What documentation is required to bill CPT 78468 instead of 78466?

To bill 78468, the interpretation report must explicitly document the calculated ejection fraction with a specific percentage value and the methodology used (gated SPECT, first-pass, etc.). Without clear ejection fraction documentation, the code should be downgraded to 78466.