Coding for diagnostic nuclear medicine procedures for the cardiovascular system
Relative to payment, is add-on CPT® code 78434 always bundled when performed in a hospital setting?
For outpatient hospital payment under OPPS (Outpatient Prospective Payment System) for Medicare, the technical component (TC) is always packaged. The professional component (26) is separately reimbursable under the Medicare Physician Fee Schedule (MPFS). By definition, CPT describes this as an “add-on” code and Medicare does not reimburse separately for the technical portion of add-on codes to hospitals under OPPS. Other non-Medicare payers, however, may reimburse for it separately.
The code and full description are as follows:
78434 Absolute quantitation of myocardial blood flow (AQMBF), positron emission tomography (PET), rest and pharmacologic stress (List separately in addition to code for primary procedure)
CPT states that the only two primary codes to be assigned with add-on code 78434 are 78492 or 78431