CPT 78472Radiology

Gated heart planar single

CPT 78472 covers a gated cardiac blood pool imaging study using a planar (2D) technique to evaluate how well your heart pumps blood. This nuclear medicine test tracks blood flow through heart chambers during different phases of the heartbeat.

Showing rates for

National Average

Base Medicare rate

$200.22

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

0.98

PE RVU (NF)

5.13

MP RVU

0.08

Total RVU

6.19

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

NCCI bundling edits

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Billing tips

Bill globally ($200.22) when your facility performs both technical and professional components; split with 26/TC modifiers only when components are separated
Impact: Prevents $50-75 loss from incorrect modifier application when facility owns both components
Document specific gating technique (ECG-triggered acquisition) and number of cardiac cycles acquired (typically 8-16 frames per cycle) to differentiate from non-gated studies
Impact: Prevents downcoding to 78445 (non-gated) which pays approximately $40-50 less
Verify that ejection fraction calculation and wall motion analysis are documented in interpretation report as these are required elements
Impact: Absence of quantitative analysis increases audit risk and potential denial of full $200.22 payment
Do not bill 78472 with 78473 (multiple studies) on the same date; use 78473 when rest and stress/exercise studies are both performed
Impact: Prevents bundling denial and potential recoupment; 78473 pays approximately $300-350 for both studies
When performed in hospital outpatient setting, ensure place of service code 22 is used; facility and non-facility rates are equal at $200.22
Impact: Maintains correct payment rate and prevents claim processing delays
Bill radiopharmaceutical separately using HCPCS A9512 (Technetium Tc-99m pertechnetate) or A9560 (Technetium Tc-99m labeled RBC) based on labeling method used
Impact: Recovers additional $75-150 in radiopharmaceutical costs not included in CPT 78472 reimbursement

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78472 in 2025?

The 2025 Medicare national average payment for CPT 78472 is $200.22 for both facility and non-facility settings. This rate is based on 6.19 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic location based on locality-specific adjustments.

What is the difference between CPT 78472 and 78473?

CPT 78472 is for a single gated cardiac blood pool study (typically resting only), while 78473 covers multiple studies performed during the same session (such as rest and stress or rest and exercise). Bill 78472 when only one acquisition is performed; bill 78473 when two or more acquisitions with different physiologic conditions are obtained.

Can CPT 78472 be billed with modifier 26 for professional component only?

Yes, modifier 26 should be appended when billing only the physician interpretation without the technical component (equipment, technologist, supplies). This is common when a physician reads studies performed at another facility. The professional component represents approximately 26-30% of the total allowed amount.

How many RVUs is CPT code 78472 worth in 2025?

CPT 78472 has 6.19 total RVUs in 2025, consisting of 0.98 work RVUs, 5.13 practice expense RVUs (both facility and non-facility), and 0.08 malpractice RVUs. These values are from the CMS Physician Fee Schedule RVU25A released December 23, 2024.

What diagnosis codes support medical necessity for CPT 78472?

Common supporting diagnoses include I50.x (heart failure), Z79.899 (long-term drug therapy including cardiotoxic chemotherapy), I25.10 (coronary artery disease), I34.x-I37.x (valvular heart disease), I42.x (cardiomyopathy), and Z01.810 (pre-procedural cardiovascular examination). Documentation must link the specific diagnosis to the need for gated functional assessment.

Is prior authorization required for CPT 78472?

Prior authorization requirements vary by payer and are increasingly common for advanced imaging. Many Medicare Advantage plans and commercial insurers require prior authorization for nuclear cardiology studies. Check specific payer policies and obtain authorization before scheduling to prevent denial of the $200.22 payment.

Can CPT 78472 be billed on the same day as a cardiac stress test?

Billing 78472 with a separate cardiac stress test (93015-93018) on the same day requires careful documentation of distinct purposes. If the gated study is performed as part of the stress protocol with multiple acquisitions, code 78473 is more appropriate. If truly separate resting gated study for different indication, append modifier 59 to prevent bundling denial.