Does CPT 78452 need a modifier?

Are they wanting you to bill 78452-TC and 78452-26? If you own your own equipment, do the service in your own office, using your own staff and supplies, and it is interpreted by your own doctor, then 78452 without a modifier.

What is included in CPT 78452?

CPT® 78452 in section: Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when more.

How much does modifier 26 reduce payment?

Modifier 26 Reimbursement The reimbursement split for a two-component service is 60 percent technical and 40 percent professional; however, this split varies by payer, geographic locations, and CPT code.

Is CPT code 78452 A nuclear stress test?

78452 : Nuclear stress : 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/ …

Is CPT 78452 nuclear medicine?

CPT® 78452, Under Diagnostic Nuclear Medicine Procedures on the Cardiovascular System. The Current Procedural Terminology (CPT®) code 78452 as maintained by American Medical Association, is a medical procedural code under the range – Diagnostic Nuclear Medicine Procedures on the Cardiovascular System.

Is 78452 a nuclear medicine?

Does Medicare allow modifier 26?

When Medicare procedures have both professional and technical components, modifiers 26 and TC may come into play. You should append modifier 26, “professional component” to a procedure code when you perform only the professional component of the service.

Does Medicare pay for CPT 78452?

Medicare Hospital Outpatient For 2021, CMS continues to package the payment for diagnostic radiopharmaceuticals, the exercise stress test, CPT 93017, and all pharmacologic stress agents with the SPECT Myocardial Perfusion Imaging (MPI) procedure, CPT 78452, into one single packaged payment.

How do I interpret a CPT code 78452?

If you own your own equipment, do the service in your own office, using your own staff and supplies, and it is interpreted by your own doctor, then 78452 without a modifier. Along with 93015 (assuming own equipment, interpretation, etc.), radiopharmaceutical and drug codes.

How to appeal CPT code 78414?

Use the instructions in the CPT book (look at the guidelines before 78414 – where it tells you to use both code/s from 93015-93018 and 78451-78454. My guess is that they have a glitch in their system and until someone appeals high enough they won’t fix it. You may have to go through the first couple of levels of appeals.

Should I Bill 78452 with a TC modifier?

Along with 93015 (assuming own equipment, interpretation, etc.), radiopharmaceutical and drug codes. “The office is telling us (we do our coding off site) that a tech does the test and a physician reads or interprets the test therefore, it is reasonable to bill the 78452 with a TC modifier.”

What do you bill for 78452 and 93015?

We bill 78452, 93015 + meds when done in house. You have to use a -25 modifier on your E&M if done same day. If test done at hospital we bill 78452-26, 93016 and 93018. I don’t know what I was thinking. In office, we do bill Medicare the 93015 with 78452 global charge and are getting paid on it.