`78496` Heart first pass add-on

What 78496 is

CMS fee schedule short descriptor: Heart first pass add-on.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 78496 (CY2026)

	Work RVU	Practice expense RVU	Malpractice RVU	Total	Medicare rate
Non-facility (office)	0.49	0.75	0.03	1.27	$42.42
Facility (hospital, ASC)	0.49	0.75	0.03	1.27	$42.42

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.

Adjust for a Medicare locality:

Status: Active - payable under the Physician Fee Schedule. Global period: Add-on code: global period of the primary procedure applies.

Medically Unlikely Edit (MUE)

Medicare caps 78496 at 1 unit per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 78496? These codes are bundled into it

78496 is a Column 1 code in 8 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 code	Short description	Modifier indicator
`36000`	Place needle in vein	1 - modifier may bypass	Check pair
`36005`	Injection ext venography	1 - modifier may bypass	Check pair
`36410`	Vnpnxr 3yr/> phy/qhp dx/ther	1 - modifier may bypass	Check pair
`36591`	Draw blood off venous device	0 - no modifier bypass	Check pair
`36592`	Collect blood from picc	0 - no modifier bypass	Check pair
`77790`	Radiation handling	0 - no modifier bypass	Check pair
`78445`	Vascular flow imaging	0 - no modifier bypass	Check pair
`96523`	Irrig drug delivery device	0 - no modifier bypass	Check pair

78496 is bundled into these codes

78496 appears as a Column 2 code in 10 active edits. Reported with one of these Column 1 codes on the same date of service, 78496 is the code that denies.

Column 1 code	Short description
`0541T`	Myocardial imaging mcg	Check pair
`0542T`	Myocardial imaging mcg i&r	Check pair
`78451`	Ht muscle image spect sing	Check pair
`78452`	Ht muscle image spect mult	Check pair
`78453`	Ht muscle image planar sing	Check pair
`78454`	Ht musc image planar mult	Check pair
`78473`	Gated heart multiple	Check pair
`78481`	Heart first pass single	Check pair
`78483`	Heart first pass multiple	Check pair
`78494`	Heart image spect	Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.