CPT CODES

CPT Code 78459

CPT code 78459 is for a myocardial imaging PET scan, a diagnostic test that evaluates heart function and blood flow in a single study.

Table of Contents
What is CPT Code 78459
Does CPT 78459 Need a Modifier?
CPT Code 78459 Medicare Reimbursement
Are You Being Underpaid for 78459 CPT Code?
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What is CPT Code 78459

CPT code 78459 is used to describe a myocardial imaging procedure using positron emission tomography (PET) for a single study. This code is specifically for a non-invasive imaging test that evaluates the blood flow to the heart muscle. It helps healthcare providers assess the presence of coronary artery disease or other heart conditions by providing detailed images of the heart's function and structure. This procedure is typically performed in a hospital or specialized imaging center and is crucial for diagnosing and managing cardiac health issues.

Does CPT 78459 Need a Modifier?

78458 - Ven thrombosis images bilat

Modifiers that could be used:

1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the images, not the technical component.

2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and facilities, not the interpretation.

3. Modifier 50 (Bilateral Procedure): Since the procedure involves bilateral imaging, this modifier is used to indicate that the procedure was performed on both sides of the body.

4. Modifier 59 (Distinct Procedural Service): This modifier may be used if the imaging is performed as a distinct service separate from other procedures on the same day.

5. Modifier 76 (Repeat Procedure by Same Physician): If the procedure needs to be repeated on the same day by the same provider, this modifier is applicable.

6. Modifier 77 (Repeat Procedure by Another Physician): If the procedure is repeated on the same day by a different provider, this modifier is used.

78459 - Myocrd img pet single study

Modifiers that could be used:

1. Modifier 26 (Professional Component): This modifier is applicable when the provider is billing only for the professional component, which includes the interpretation of the PET scan.

2. Modifier TC (Technical Component): This modifier is used when billing solely for the technical component, which involves the use of equipment and facilities for the PET scan.

3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the PET scan is performed as a distinct service separate from other procedures on the same day.

4. Modifier 76 (Repeat Procedure by Same Physician): If the PET scan needs to be repeated on the same day by the same provider, this modifier is applicable.

5. Modifier 77 (Repeat Procedure by Another Physician): If the PET scan is repeated on the same day by a different provider, this modifier is used.

CPT Code 78459 Medicare Reimbursement

The CPT code 78459 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors.

The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of fees that Medicare uses to reimburse healthcare providers for services rendered, including those associated with CPT code 78459.

However, the actual reimbursement rate can differ depending on the geographical location and the specific Medicare Administrative Contractor (MAC) that processes claims in that area.

Each MAC may have slightly different interpretations and implementations of Medicare policies, which can affect the reimbursement process.

Therefore, it is crucial for healthcare providers to verify the reimbursement details with their respective MAC to ensure accurate billing and reimbursement for CPT code 78459.

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