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    v1.0.30
    OpenPayerBilling CodesDiagnostic Nuclear Medicine Procedures on the Nervous SystemCPT cpt-78645-csf-shunt-flow-imaging
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    CPT 78645: CSF Shunt Patency and Flow Imaging Study

    Medicare pays $199 on average nationally for this procedure.

    CPT code 78645 describes imaging used to evaluate the patency and function of a cerebrospinal fluid (CSF) shunt system by visualizing CSF flow; this is a diagnostic shunt patency study typically performed by a radiology or neurosurgery service and usually carried out in an outpatient radiology suite or hospital imaging department using fluoroscopic or nuclear medicine techniques to assess shunt function and identify obstruction or leakage.

    For related coverage guidance, see recent payer policy updates: Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM), Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®), Lumbar Microdiscectomy.

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    Clinical & Coding Specifications

    Clinical Context

    A 45-year-old patient with a ventriculoperitoneal (VP) cerebrospinal fluid (CSF) shunt presents with progressive headaches, nausea, and intermittent confusion. The neurosurgeon suspects shunt malfunction or partial obstruction. The clinical workflow begins with outpatient triage and neurologic assessment, followed by orders for shunt patency imaging. In the radiology suite or nuclear medicine department, the patient receives a small intrathecal injection of radiotracer via lumbar puncture or through a shunt reservoir under sterile technique. Dynamic and delayed images are obtained to visualize CSF flow through the proximal and distal shunt tubing and to confirm flow to the peritoneal cavity or other drainage site. Images are interpreted by a neuroradiologist or nuclear medicine physician; results are communicated to the referring neurosurgeon to guide decisions about shunt revision, externalization, or conservative management. Typical site of service is an outpatient radiology or nuclear medicine department, or inpatient/observation setting when the patient is admitted for suspected acute shunt failure.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    70553Magnetic resonance (MR) head without and with contrast material; followed by imaging sequencesMay be used to evaluate intracranial pathology or hydrocephalus anatomy prior to or after shunt patency imaging.
    77080Fluoroscopic guidance for needle placement (e.g., for intrathecal injection)Used when fluoroscopic guidance is required to place a lumbar puncture needle or access a shunt reservoir for tracer injection.
    99213Office or other outpatient visit for evaluation and management of an established patient, low to moderate complexityTypical outpatient visit for evaluation of shunt symptoms and ordering of imaging.
    62270Spinal puncture, cisternal or lumbar, diagnostic (separate procedure)Performed when CSF is obtained or intrathecal access is needed as part of the study.
    96120Quantitative neurophysiology (not directly related)Data not available in the input.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RB0002X
    261QP2300X
    207SG0207X
    363LA2200X
    273Y00000X
    2251H1200X
    207ZP0102X
    261QS0112X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    F01.50Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    F03.90Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    F05Delirium due to known physiological condition
    G91.0Communicating hydrocephalus
    G91.1Obstructive hydrocephalus
    G91.2(Idiopathic) normal pressure hydrocephalus
    G91.8Other hydrocephalus
    G91.9Hydrocephalus, unspecified
    G93.5Compression of brain
    G93.6Cerebral edema

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 2

    10 rows

    PolicyPayerEffective Date
    Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)Kaiser Permanente2027-01-01
    Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)bcbsvermont2026-11-01
    Lumbar Microdiscectomyuniverahealthcare2026-10-15
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Decompressionuniverahealthcare2026-10-15
    Responsive Neurostimulation for Focal EpilepsyPremera Bluecross2026-10-14
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    High-Intensity Focused UltrasoundMass General Brigham Health Plan2026-10-01
    Vagal Nerve StimulationAmbetter Nevada2026-10-01

    Related Codes

    CPT-78600-BRAIN-NUCLEAR-STATIC-IMAGING-FEWER-THAN-FOUR-VIEWS

    CPT 78600: Nuclear Diagnostic Brain Imaging, <4 Static Views

    CPT-78601-BRAIN-NUCLEAR-PERFUSION-IMAGING-FEWER-THAN-FOUR-STATIC-VIEWS

    CPT 78601: Nuclear Diagnostic Brain Imaging, Static Views and Flow

    CPT-78605-BRAIN-NUCLEAR-STATIC-IMAGING-FOUR-OR-MORE-VIEWS

    CPT 78605: Brain Nuclear Diagnostic Imaging, Four+ Static Views

    CPT-78606-NUCLEAR-BRAIN-IMAGING-STATIC-VIEWS-CEREBRAL-BLOOD-FLOW

    CPT 78606: Brain Nuclear Imaging, Static Views with Flow Evaluation

    CPT-78608-PET-BRAIN-METABOLIC-IMAGING

    CPT 78608: Brain PET for Cerebral Metabolic Imaging

    CPT-78609-PET-BRAIN-IMAGING

    CPT 78609: Brain PET Scan for Function and Perfusion

    CPT-78610-CEREBRAL-PERFUSION-NUCLEAR-MEDICINE-STUDY

    CPT 78610: Brain Perfusion Study with Gamma Tracer

    CPT-78630-CSF-FLOW-STUDY-HYDROCEPHALUS-LEAK-EVALUATION

    CPT 78630: Cerebrospinal Fluid (CSF) Flow Study, Head

    CPT-78635-CSF-FLOW-VENTRICULAR-IMAGING-HYDROCEPHALUS

    CPT 78635: CSF Flow Study for Ventricular Assessment

    CPT-78650-CSF-LEAK-NUCLEAR-IMAGING-LOCALIZATION

    CPT 78650: Nuclear Medicine Localization of CSF Leak

    Showing 1–10 of 12

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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