CPT 78473Radiology

Gated heart multiple

CPT code 78473 is for a specialized heart imaging test that uses radioactive tracers to create multiple pictures of the heart as it beats, helping doctors evaluate how well the heart pumps blood.

Showing rates for

National Average

Base Medicare rate

$254.57

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

1.47

PE RVU (NF)

6.31

MP RVU

0.09

Total RVU

7.87

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

NCCI bundling edits

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Billing tips

Verify split billing arrangements between hospital and physician practice - determine who bills technical vs professional components to avoid duplicate billing
Impact: Prevents claim denials and potential fraud investigations; ensures proper component billing for full $254.57 reimbursement
Document specific cardiac cycle phases captured (end-systole, end-diastole) and number of gating intervals in the report
Impact: Reduces medical necessity denials by 40-60% and supports medical review appeals
Include ejection fraction calculations and wall motion analysis in the final report, not just image acquisition documentation
Impact: Required for payment; missing calculations result in downcoding or denial of entire $254.57 claim
Bill on same date of service as radiopharmaceutical administration; use appropriate A9500-A9699 HCPCS codes for the radiotracer separately
Impact: Radiopharmaceutical reimbursement is separate from imaging study; failing to bill separately loses $150-400 in additional revenue
For Medicare patients, ensure ordering physician documents appropriate use criteria (AUC) consultation and PAMA compliance
Impact: Required since January 2023; missing AUC documentation triggers claim holds and potential denials starting in 2025
When billing with stress testing codes, verify LCD/NCD requirements for medical necessity of both rest and stress components
Impact: Combination billing without proper indication documentation results in 30-50% denial rate for the nuclear imaging component

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 78473 in 2025?

The 2025 Medicare national average reimbursement for CPT 78473 is $254.57 for both facility and non-facility settings. This rate is based on 7.87 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality and payer contract.

Can CPT 78473 be billed with a stress test on the same day?

Yes, CPT 78473 can be billed with cardiac stress testing codes when medically appropriate, but documentation must clearly indicate both rest and stress imaging were performed as part of a comprehensive evaluation. Use appropriate exercise or pharmacologic stress codes (93015-93018, 93016-93018) and ensure medical necessity supports the complete protocol.

What is the difference between CPT 78473 and 78472?

CPT 78472 is for gated equilibrium cardiac imaging with a single study, while 78473 represents multiple gated studies (typically rest and stress or multiple time points). Code 78473 has higher RVUs and reimbursement due to the additional imaging acquisitions and interpretive work required for multiple datasets.

How often can CPT 78473 be billed for chemotherapy monitoring?

Medicare LCD policies typically allow MUGA scans every 3-4 chemotherapy cycles for cardiotoxic agents like doxorubicin or trastuzumab. More frequent monitoring requires documentation of dose escalation, symptom development, or prior abnormal results. Commercial payers may have different frequency limitations requiring prior authorization.

What diagnosis codes support medical necessity for CPT 78473?

Common supporting ICD-10 codes include I50.x (heart failure variants), Z51.11 (encounter for chemotherapy), C50.x (breast cancer with cardiotoxic treatment), I25.5 (ischemic cardiomyopathy), and I42.x (cardiomyopathy types). Documentation must link the diagnosis to the clinical question requiring gated cardiac imaging.

Do I need to bill modifier 26 or TC with CPT 78473?

Split billing requires modifiers: use modifier 26 for professional component (physician interpretation only) or TC for technical component (equipment, staff, supplies). Global billing (no modifier) is appropriate when the same entity provides both components. Verify your practice's arrangement to avoid duplicate or incorrect billing.

What are the work RVUs for CPT code 78473 in 2025?

CPT 78473 has 1.47 work RVUs, 6.31 practice expense RVUs (both facility and non-facility), and 0.09 malpractice RVUs, totaling 7.87 RVUs in 2025. These values are from the CMS Physician Fee Schedule RVU25A released December 23, 2024.