CPT 78582Radiology

Lung ventilat&perfus imaging

CPT code 78582 covers lung ventilation and perfusion imaging (V/Q scan), a nuclear medicine test that checks both airflow and blood flow in the lungs to detect problems like blood clots or breathing disorders.

Showing rates for

National Average

Base Medicare rate

$287.56

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

1.07

PE RVU (NF)

7.74

MP RVU

0.08

Total RVU

8.89

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

NCCI bundling edits

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Billing tips

Always verify that both ventilation AND perfusion components were performed and documented before billing 78582; if only one component completed, bill the appropriate single-phase code instead
Impact: Prevents downcoding and potential recoupment; difference between $287.56 (78582) versus approximately $200-220 for single-phase studies
Document the specific radiopharmaceuticals used for both phases (e.g., Tc-99m MAA for perfusion, Xe-133 or Tc-99m DTPA aerosol for ventilation) to support medical necessity and proper coding
Impact: Reduces audit risk and supports full reimbursement; missing radiopharmaceutical documentation is a common reason for medical review
Bill professional (26) and technical (TC) components separately when services are split between facility and interpreting physician to maximize compliant reimbursement
Impact: Ensures both entities receive appropriate payment; prevents leaving money on the table when split-billing scenario exists
For Medicare patients, verify medical necessity documentation explicitly addresses why V/Q scan was chosen over CT pulmonary angiography, particularly noting contraindications to CT contrast if applicable
Impact: Medicare increasingly scrutinizes V/Q scans given preference for CTPA; strong justification prevents denials and maintains $287.56 payment
Report radiopharmaceutical supply codes (A9500-A9699 series) separately as these are not included in the CPT 78582 reimbursement
Impact: Additional reimbursement of $150-300+ depending on specific radiopharmaceuticals used; commonly overlooked revenue opportunity
When billing globally (no modifier), ensure your facility has the appropriate equipment, licensed personnel, and radioactive materials license, as Medicare audits frequently verify these requirements

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78582 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78582 is $287.56 for both facility and non-facility settings. This rate is based on 8.89 total RVUs (1.07 work RVU + 7.74 PE RVU + 0.08 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic locality adjustments.

What is the difference between CPT 78582 and 78597?

CPT 78582 is a combined ventilation and perfusion lung imaging study, while 78597 represents only the perfusion (blood flow) component. Code 78582 requires documentation of both ventilation and perfusion imaging and reimburses at $287.56, whereas 78597 (perfusion only) reimburses at a lower rate. Always bill 78582 when both components are performed and documented.

Can CPT 78582 be billed with a chest X-ray on the same day?

Yes, CPT 78582 can be billed with a chest X-ray (71045, 71046, 71047, 71048) on the same day without modifier 59, as they are not bundled per CCI edits. In fact, a recent chest X-ray is clinically recommended prior to V/Q scanning to exclude other pathology and to properly interpret V/Q scan results. Both services can be reimbursed separately when medically appropriate.

How do I bill CPT 78582 when the radiologist only reads the study?

When the radiologist or nuclear medicine physician only provides the interpretation (professional component), bill CPT 78582-26. The facility that provides the equipment, technologist, and radiopharmaceuticals bills 78582-TC (technical component). The sum of 26 and TC components equals the global reimbursement of $287.56, typically split approximately 12-15% professional and 85-88% technical.

What diagnosis codes support medical necessity for CPT 78582?

Common supporting ICD-10 codes include I26.x (pulmonary embolism), I27.82 (chronic pulmonary embolism), R06.02 (shortness of breath), R07.1 (chest pain on breathing), Z85.71 (history of PE), and pre-operative evaluation codes for lung resection candidates. Documentation should clearly link the clinical presentation to the need for V/Q imaging, particularly explaining why CT angiography is not appropriate if that is the case.

Are radiopharmaceuticals included in CPT 78582 reimbursement?

No, radiopharmaceuticals are not included in the CPT 78582 reimbursement and should be billed separately using HCPCS codes A9500-A9699. Common codes include A9539 (Tc-99m MAA for perfusion) and A9567 (Tc-99m aerosol for ventilation) or A9558 (Xenon Xe-133). These additional supplies typically add $150-300+ in reimbursement beyond the $287.56 for the procedure itself.

What are the work RVUs for CPT code 78582?

CPT code 78582 has 1.07 work RVUs for 2025 according to the CMS Medicare Physician Fee Schedule. The total RVU value is 8.89, which includes 1.07 work RVU, 7.74 practice expense RVU (both facility and non-facility), and 0.08 malpractice RVU. The relatively high practice expense RVU reflects the significant equipment and radiopharmaceutical costs associated with nuclear medicine procedures.