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78451
Quick jump to procedure code: Printer Friendly Version
78453

CPT® 78452: MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIES, AT REST AND/OR STRESS (EXERCISE OR PHARMACOLOGIC) AND/OR REDISTRIBUTION AND/OR REST REINJECTION

Short Description: Ht muscle image spect mult

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
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WYOMING-Entire State

2016 Physician
Fee Schedule:

Global Fee $492.28
26 Modifier $ 80.25
TC Modifier $412.02

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 JulyUnadjusted OPPS Payment $1108.46


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5593
Level 3 Nuclear Medicine and Related Services

2016 OPPS Status Indicator: S

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
17.3% 786.50    Chest pain, unspecified R07.9   Chest pain, unspecified
12.1% 414.01    Coronary atherosclerosis of native coronary artery I25.10   Atherosclerotic heart disease of native coronary artery without angina pectoris
6.8% 794.31    Abnormal electrocardiogram [ECG] [EKG] R94.31   Abnormal electrocardiogram [ECG] [EKG]
6.6% 786.05    Shortness of breath R06.02   Shortness of breath
5.2% 414.00    Coronary atherosclerosis of unspecified vessel I25.10   Atherosclerotic heart disease of native coronary artery without angina pectoris
3.0% 401.1    Benign hypertension I10   Essential (primary) hypertension
2.8% 413.9    Other and unspecified angina pectoris I20.8   Other forms of angina pectoris
OR:
I20.9   Angina pectoris, unspecified
2.8% 401.9    Unspecified hypertension I10   Essential (primary) hypertension
2.6% 786.51    Precordial pain R07.2   Precordial pain
2.5% 786.59    Other chest pain R07.82   Intercostal pain
OR:
R07.89   Other chest pain

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

78452 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 78452

CCI and MUE Edits*         Hide this section.

CCI Edits for 78452
Denied Codes (1)
Effective
Modifier
Accepted (2)
36000 Place needle in vein
01/01/2010 Yes
36005 Injection ext venography
01/01/2010 Yes
36410 Non-routine bl draw 3/> yrs
01/01/2010 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
76000 Fluoroscope examination
01/01/2010 Yes
76001 Fluoroscope exam extensive
01/01/2011 Yes
76376 3d render w/intrp postproces
01/01/2010 Yes
76377 3d render w/intrp postproces
01/01/2010 Yes
76942 Echo guide for biopsy
01/01/2010 Yes
76998 Us guide intraop
01/01/2010 Yes
77001 Fluoroguide for vein device
01/01/2011 Yes
77002 Needle localization by xray
01/01/2010 Yes
77790 Radiation handling
07/01/2014 No
78445 Vascular flow imaging
10/01/2012 No
78451 Ht muscle image spect sing
01/01/2010 No
78453 Ht muscle image planar sing
01/01/2010 No
78454 Ht musc image planar mult
01/01/2010 No
78472 Gated heart planar single
01/01/2010 No
78473 Gated heart multiple
01/01/2010 No
78481 Heart first pass single
01/01/2010 No
78483 Heart first pass multiple
01/01/2010 No
78494 Heart image spect
07/01/2010 No
78496 Heart first pass add-on
01/01/2010 No
78580 Lung perfusion imaging
01/01/2010 No
78582 Lung ventilat&perfus imaging
01/01/2012 No
78597 Lung perfusion differential
01/01/2012 No
78598 Lung perf&ventilat diferentl
01/01/2012 No
78635 Csf ventriculography
01/01/2010 No
96360 Hydration iv infusion init
01/01/2010 Yes
96365 Ther/proph/diag iv inf init
01/01/2010 Yes
96372 Ther/proph/diag inj sc/im
01/01/2010 Yes
96374 Ther/proph/diag inj iv push
01/01/2010 Yes
96375 Tx/pro/dx inj new drug addon
01/01/2010 Yes
96376 Tx/pro/dx inj same drug adon
01/01/2010 Yes
A9501 Technetium tc-99m teboroxime
10/01/2015 No
A9503 Tc99m medronate
10/01/2015 No
A9504 Tc99m apcitide
10/01/2015 No
A9508 I131 iodobenguate, dx
10/01/2015 No
A9510 Tc99m disofenin
10/01/2015 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
A9512 Tc99m pertechnetate
10/01/2015 No
A9516 Iodine i-123 sod iodide mic
10/01/2015 No
A9517 I131 iodide cap, rx
10/01/2015 No
A9521 Tc99m exametazime
10/01/2015 No
A9524 I131 serum albumin, dx
10/01/2015 No
A9526 Nitrogen n-13 ammonia
10/01/2015 No
A9527 Iodine i-125 sodium iodide
10/01/2015 No
A9528 Iodine i-131 iodide cap, dx
10/01/2015 No
A9536 Tc99m depreotide
10/01/2015 No
A9537 Tc99m mebrofenin
10/01/2015 No
A9538 Tc99m pyrophosphate
10/01/2015 No
A9539 Tc99m pentetate
10/01/2015 No
A9540 Tc99m maa
10/01/2015 No
A9541 Tc99m sulfur colloid
10/01/2015 No
A9542 In111 ibritumomab, dx
10/01/2015 No
A9547 In111 oxyquinoline
10/01/2015 No
A9548 In111 pentetate
10/01/2015 No
A9550 Tc99m gluceptate
10/01/2015 No
A9551 Tc99m succimer
10/01/2015 No
A9552 F18 fdg
10/01/2015 Yes
A9554 I125 iothalamate, dx
10/01/2015 No
A9555 Rb82 rubidium
10/01/2015 Yes
A9556 Ga67 gallium
10/01/2015 No
A9557 Tc99m bicisate
10/01/2015 No
A9558 Xe133 xenon 10mci
10/01/2015 No
A9559 Co57 cyano
10/01/2015 No
A9560 Tc99m labeled rbc
10/01/2015 Yes
A9561 Tc99m oxidronate
10/01/2015 No
A9562 Tc99m mertiatide
10/01/2015 No
A9567 Technetium tc-99m aerosol
10/01/2015 No
A9568 Technetium tc99m arcitumomab
10/01/2015 No
A9570 Indium in-111 auto wbc
10/01/2015 No
A9572 Indium in-111 pentetreotide
10/01/2015 No
A9580 Sodium fluoride f-18
10/01/2015 No
A9582 Iodine i-123 iobenguane
10/01/2015 No
A9600 Sr89 strontium
10/01/2015 Yes
A9604 Sm 153 lexidronam
10/01/2015 Yes
J1642 Inj heparin sodium per 10 u
01/01/2010 Yes
79101 Nuclear rx iv admin
01/01/2011 No
(1) These codes will be denied when submitted for payment on the same date of service as 78452.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 78452


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Nature of Service/Procedure Nature of Service/Procedure Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   78452 Top 5 Ordering Providers National*
CAROLYN CORN -OKLAHOMA CITY,OK 2,387
MICHAEL HAUSER -OKLAHOMA CITY,OK 2,285
THOMAS WATTERS -SAN MATEO,CA 1,908
RODNEY RANDALL -TAMPA,FL 1,430
SAM BORNO -FRESNO,CA 1,371

   78452 Top 5 Ordering Organizations National*
DIRECT DIAGNOSTIC SERVICES, LLC-NC 838
MED SHARE INC-MI 734
NORTH BAY CARDIAC IMAGING INC-CA 658
CASCADE MEDICAL IMAGING LLC-OR 578
HIGH TECHNOLOGY INC-IL 516

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 78452*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 2,320,439
Total Services Denied 2014: 188,797 (8.1%)
National Charges Submitted 2014: $1,789,117,355.00
National Charges Allowed 2014: $573,763,041.00
National Average (No Modifier) Fee Submitted 2014: $1278.94
National Average (No Modifier) Fee Allowed 2014: $491.49
National Average (26) Fee Submitted 2014: $318.83
National Average (26) Fee Allowed 2014: $ 79.67
National Average (TC) Fee Submitted 2014: $1133.36
National Average (TC) Fee Allowed 2014: $393.37


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Cardiology 1,790,472 77.2% $841.34 138,101 7.7%
Diagnostic radiology 294,505 12.7% $353.07 27,988 9.5%
Internal medicine 101,857 4.4% $887.01 9,532 9.4%
Nuclear medicine 74,608 3.2% $483.38 6,359 8.5%
Pathologic anatomy, clinical pathology
(osteopaths only)
(discontinued 5/92 use code 22)
14,543 0.6% $747.81 1,095 7.5%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 1,218,330 52.5% $1179.16 112,740 9.3%
Outpatient hospital 818,625 35.3% $314.73 49,245 6.0%
Inpatient hospital 255,205 11.0% $329.15 22,181 8.7%
Emergency room - hospital 26,007 1.1% $326.31 4,367 16.8%
Mobile Unit (eff. 1/1/03) 659 0.0% $1093.09 49 7.4%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 1,211,410 52.2% $318.83 80,924 6.7%
No Modifier 986,735 42.5% $1278.94 93,126 9.4%
TC - Technical Component 95,005 4.1% $1133.36 9,994 10.5%
GA - Advanced Beneficiary Notice (ABN) on File 10,827 0.5% $1205.20 2,308 21.3%
59 - Distinct Procedural Service 10,276 0.4% $1178.72 1,364 13.3%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


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07/24/2016 09:44:57 54.224.34.226

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