2025 CPT code 78496
(Active) Effective Date: N/A Revision Date: N/A Diagnostic Imaging - Nuclear Medicine Procedures Radiology Feed
Add-on code for right ventricular ejection fraction assessment via first-pass technique during cardiac blood pool imaging.
Modifiers may be applicable depending on the circumstances of the service (e.g., 26 for professional component). Consult current payer guidelines for specific requirements.
Medical necessity for 78496 is established when the physician determines that assessment of right ventricular function is clinically indicated due to symptoms or findings suggestive of right ventricular dysfunction (e.g., pulmonary hypertension, heart failure, valvular disease).
The nuclear medicine physician or technologist is responsible for administering the radiotracer, acquiring the images, and interpreting the results, in conjunction with the cardiologist who ordered the test and interprets the overall cardiac study.
In simple words: This code is added to the main heart imaging test bill to show that a special technique was used to measure how well one part of the heart is pumping blood.It's not billed separately; it's added on to another heart test bill.
This CPT code, 78496, represents an add-on code used in conjunction with the primary cardiac blood pool imaging procedure (such as 78472 or 78473). It specifically covers the assessment of right ventricular ejection fraction using the first-pass technique. This technique involves the rapid visualization of the passage of a radiotracer through the heart chambers, providing functional information about the right ventricle's pumping ability.This code should only be reported in addition to the primary cardiac blood pool imaging code. It is not a standalone procedure.
Example 1: A patient presents with suspected right ventricular dysfunction.A cardiac blood pool study (78472) is ordered, and the first-pass technique is used to assess the right ventricular ejection fraction. 78496 is added to the bill., A patient undergoing chemotherapy for lung cancer develops signs of heart failure. A cardiac blood pool study is ordered, and 78496 is included in the billing to assess right ventricular function., A patient with a history of pulmonary hypertension undergoes a cardiac blood pool study to assess both the left and right ventricular ejection fractions.78472 and 78496 are reported.
*Physician's order specifying the need for right ventricular ejection fraction assessment.*Radiology report detailing the imaging technique, findings, and interpretation.*Patient's medical history and clinical presentation.*Documentation of any pre-procedure medication or preparation.
** Always reference the most current CPT codebook and payer guidelines for accurate coding and reimbursement.
- Revenue Code: 0360
- RVU: The RVUs for this add-on code will vary based on geographic location and payer.Consult your local fee schedule or payer specific guidelines for accurate RVU values.
- Global Days: This is an add-on code; therefore, no global period applies. The global period is determined by the primary procedure code.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not applicable to this add-on code.
- Fee Schedule: Historical fee schedule data is unavailable for this specific add-on code. Consult your payer for the most up-to-date fee schedule information.
- Specialties:Cardiology, Nuclear Medicine
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center