Revised Reimbursement Rate CPT Code 78434 and 78434-TC Effective for Claims Processed on or After November 6

As part of ongoing payment integrity and pricing oversight activities, a review of contractor reimbursement identified that the locally established payment amount for CPT 78434 and 78434-TC differed from rates currently used by other MACs. Consistent with our responsibility to maintain accurate and equitable payment methodologies, we have repriced CPT 78434 and 78434-TC to align with prevailing MAC reimbursement rates.

This adjustment is intended to promote consistency in contractor payment practices, support appropriate access to covered services, and ensure equitable reimbursement across jurisdictions.

Effective November 6, 2026, the revised reimbursement rate will apply to all claims submitted with CPT 78434 and 78434-TC, regardless of the date of service.

Providers should be aware that claims processed on or after November 6, 2026, may reflect the updated reimbursement amount. No change has been made to existing coverage policies, medical necessity requirements, coding instructions, documentation standards, or claim submission requirements. Providers remain responsible for complying with all applicable Medicare billing and documentation requirements.

This administrative repricing action supports payment consistency across MAC jurisdictions and reflects our commitment to sound fiscal stewardship of the Medicare Trust Funds while maintaining beneficiary access to medically necessary services.