CPT 78469
Global XXX ActiveHeart infarct image (3d)
CPT 78469 Billing & Documentation Guide
CPT code 78469 (Heart infarct image (3d)) is classified under Radiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.9, a non-facility practice expense RVU of 5.12, and a malpractice RVU of 0.08, a total non-facility RVU of 6.1 and facility RVU of 6.1. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $211.44, though rates vary from $178.34 to $281.4 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 78469, 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 78469 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 78469 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 78469
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.9 | 0.9 |
| Practice Expense RVU | 5.12 | 5.12 |
| Malpractice RVU | 0.08 | 0.08 |
| Total RVU | 6.1 | 6.1 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 78469
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 | $234.94 | $234.94 | $219.43 - $281.4 | 29 |
| Florida | $206.84 | $206.84 | $197.56 - $214.84 | 3 |
| Georgia | $196.45 | $196.45 | $185.79 - $207.11 | 2 |
| Illinois | $200.51 | $200.51 | $190.37 - $210.64 | 4 |
| Michigan | $194.4 | $194.4 | $189.21 - $199.59 | 2 |
| North Carolina | $191.32 | $191.32 | $191.32 - $191.32 | 1 |
| New York | $225.9 | $225.9 | $194.4 - $240.28 | 5 |
| Ohio | $188.89 | $188.89 | $188.89 - $188.89 | 1 |
| Pennsylvania | $200.7 | $200.7 | $189.58 - $211.81 | 2 |
| Texas | $201.07 | $201.07 | $188.16 - $213.42 | 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 78469
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 78469 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0331T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0332T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 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 |
Frequently Asked Questions, CPT 78469
What does CPT code 78469 mean? +
CPT code 78469 represents: Heart infarct image (3d). It's in the Radiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 78469? +
The 2026 Medicare national average non-facility payment for CPT 78469 is $211.44. Rates range from $178.34 to $281.4 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 78469? +
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 78469? +
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 1, 2026.
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