CPT 78428
Global XXX ActiveCardiac shunt imaging
CPT 78428 Billing & Documentation Guide
CPT code 78428 (Cardiac shunt imaging) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.76, a non-facility practice expense RVU of 4.29, and a malpractice RVU of 0.07, a total non-facility RVU of 5.12 and facility RVU of 5.12. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $177.45, though rates vary from $149.67 to $236.05 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 78428, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 78428 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 78428 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 78428
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.76 | 0.76 |
| Practice Expense RVU | 4.29 | 4.29 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 5.12 | 5.12 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 78428
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $197.12 | $197.12 | $184.12 - $236.05 | 29 |
| Florida | $173.7 | $173.7 | $165.88 - $180.46 | 3 |
| Georgia | $164.92 | $164.92 | $155.99 - $173.85 | 2 |
| Illinois | $168.39 | $168.39 | $159.86 - $176.86 | 4 |
| Michigan | $163.23 | $163.23 | $158.85 - $167.6 | 2 |
| North Carolina | $160.57 | $160.57 | $160.57 - $160.57 | 1 |
| New York | $189.62 | $189.62 | $163.15 - $201.72 | 5 |
| Ohio | $158.57 | $158.57 | $158.57 - $158.57 | 1 |
| Pennsylvania | $168.47 | $168.47 | $159.13 - $177.8 | 2 |
| Texas | $168.77 | $168.77 | $157.95 - $179.11 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 78428
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 78428 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0394T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0395T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0694T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36005 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 78428
What does CPT code 78428 mean? +
CPT code 78428 represents: Cardiac shunt imaging. It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 78428? +
The 2026 Medicare national average non-facility payment for CPT 78428 is $177.45. Rates range from $149.67 to $236.05 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 78428? +
Radiology codes rely heavily on the professional/technical split: modifier 26 (professional component only) and TC (technical component only). Also common: 50 (bilateral imaging), 76 (repeat by same physician), 77 (repeat by different physician), and LT/RT for laterality.
What bundling edits apply to CPT 78428? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 2, 2026.
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