CPT 78597Radiology

Lung perfusion differential

CPT code 78597 represents a specialized nuclear medicine scan that measures blood flow differences between the left and right lungs using radioactive tracers. This test helps doctors determine if one lung is receiving less blood flow than the other, which can indicate blockages or other serious lung conditions.

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

0.75

PE RVU (NF)

4.63

MP RVU

0.06

Total RVU

5.44

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

NCCI bundling edits

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Billing tips

Document the specific percentage contribution of each lung to total perfusion (e.g., 'right lung 58%, left lung 42%') in the report
Impact: Critical for distinguishing 78597 from basic perfusion scan 78580; missing differential data can result in downcoding and loss of approximately $60-80
Verify whether the study includes ventilation imaging; if both ventilation and perfusion with differential are performed, consider 78598 instead
Impact: CPT 78598 reimburses higher when both components are performed; using wrong code can result in underpayment
Submit claims promptly as nuclear medicine studies have high supply costs; delayed billing can impact cash flow significantly
Impact: Radiopharmaceutical costs for Tc-99m MAA can exceed $150; timely billing within 30 days optimizes revenue cycle
For pre-operative evaluations, link diagnosis codes indicating planned surgery or need for surgical assessment
Impact: Medical necessity documentation prevents denials; proper linkage to codes like Z00.00 (general examination) without surgical context increases denial risk by 40%
Bill 78597 separately from ventilation studies (78579, 78582) when performed as distinct procedures on different dates
Impact: Prevents bundling and ensures full reimbursement for each service; same-day billing requires modifier 59 and strong medical necessity documentation
Verify payer-specific requirements for radiopharmaceutical HCPCS codes; some payers require separate billing of A9541 or A9542
Impact: Additional reimbursement of $80-150 for radiopharmaceuticals when separately billable; Medicare typically bundles these into the procedure payment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78597 in 2025?

The 2025 Medicare national average reimbursement for CPT 78597 is $175.96 for both facility and non-facility settings. This rate is based on 5.44 total RVUs (0.75 work RVU, 4.63 practice expense RVU, 0.06 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 78597 and 78580?

CPT 78580 is a basic lung perfusion scan that visualizes blood flow to the lungs, while CPT 78597 includes additional quantitative differential analysis calculating the percentage contribution of each lung to total perfusion. Code 78597 requires documentation of specific percentages (e.g., right lung 60%, left lung 40%) and is typically used for pre-surgical assessment or unilateral lung disease evaluation.

Can CPT 78597 be billed with a ventilation scan on the same day?

If both ventilation and perfusion with differential are performed together, you should typically use CPT 78598 instead, which includes both components. If they are performed as truly separate procedures for different clinical indications on the same day, you may bill separately with modifier 59, but this requires strong documentation of medical necessity for each distinct procedure.

What documentation is required to justify billing 78597 instead of 78580?

You must document the quantitative differential analysis showing the specific percentage contribution of the right and left lungs to total perfusion. The report should explicitly state these percentages and include clinical justification for why differential quantification was necessary, such as pre-operative lung resection planning or assessment of unilateral pulmonary disease.

How many RVUs is CPT code 78597 worth in 2025?

CPT 78597 has a total of 5.44 RVUs in 2025, consisting of 0.75 work RVUs, 4.63 practice expense RVUs (both facility and non-facility), and 0.06 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

What are the most common denial reasons for CPT 78597?

The most common denials include: lack of medical necessity documentation, downcoding to 78580 when the report lacks specific differential percentages, bundling with same-day ventilation or other pulmonary imaging, and duplicate service denials when billed too soon after previous lung imaging. Proper documentation of quantitative differential analysis and clinical indication prevents most denials.

Who can perform and bill for CPT 78597?

CPT 78597 is typically performed by certified nuclear medicine technologists and interpreted by physicians board-certified in nuclear medicine or diagnostic radiology with nuclear medicine training. The facility must have appropriate radioactive materials licensing. Radiologists, nuclear medicine physicians, and sometimes pulmonologists bill for the interpretation, while hospitals or imaging centers bill for the technical component.