2025 CPT code 78434
(Active) Effective Date: N/A Revision Date: N/A Radiology - Nuclear Medicine Procedures Radiology Feed
Absolute quantitation of myocardial blood flow (AQMBF), positron emission tomography (PET), rest and pharmacologic stress.Reported in addition to the primary procedure code.
Modifiers -26 (professional component) and -TC (technical component) may be appended depending on the service rendered and payer specific rules.
Medical necessity for this procedure is established by the presence of symptoms suggestive of coronary artery disease (e.g., chest pain, shortness of breath), risk factors for CAD (e.g., hypertension, diabetes, hyperlipidemia, family history), or abnormal results from previous non-invasive cardiac tests.Quantitative assessment of myocardial blood flow may offer advantages over qualitative methods in certain scenarios, such as determining the extent of disease, guiding revascularization strategies, or evaluating the effectiveness of interventions.Payers may have specific criteria that must be met to authorize this study.
The clinical responsibility encompasses the administration of the radiopharmaceutical, acquisition of PET images at rest and under pharmacologic stress, image analysis and interpretation, and generation of a comprehensive report providing quantitative data on myocardial blood flow.This may involve a nuclear medicine physician or a cardiologist with expertise in nuclear cardiology.
In simple words: This medical test uses a special scan (PET) to measure how well blood flows to the heart muscle, both when the heart is at rest and when it's working harder (under stress from medication).The results give doctors a very accurate picture of heart health and help diagnose heart problems.
This CPT code, 78434, represents the absolute quantitation of myocardial blood flow (AQMBF) using positron emission tomography (PET) imaging. The procedure involves acquiring images both at rest and during pharmacologic stress.The test is used to assess myocardial perfusion, allowing for a precise measurement of blood flow to the heart muscle. This quantitative assessment enhances the diagnostic accuracy of coronary artery disease (CAD) evaluation, providing more detailed information on the extent and severity of the disease compared to qualitative methods.It's crucial to note that this code is an add-on code, meaning it must always be reported with a primary procedure code, such as those for stress testing (e.g., 93015-93018).The code does not include the cost of the radiopharmaceutical or the pharmacologic stress agent; these must be billed separately using appropriate supply codes. The interpretation of the images may be reported separately by using modifier 26.
Example 1: A 65-year-old male patient presents with chest pain and suspected coronary artery disease.A pharmacologic stress test with PET imaging (including code 78434 for AQMBF) is ordered to quantitatively assess myocardial perfusion. The results reveal significant perfusion defects in the inferior wall, consistent with multi-vessel disease. This information guides the patient's treatment plan, including the decision for coronary angiography., A 70-year-old female patient with a history of hypertension and diabetes undergoes a rest-stress PET myocardial perfusion study (including code 78434) to evaluate for evidence of ischemia after experiencing episodes of shortness of breath. The quantitative analysis reveals a mild reduction in myocardial blood flow in the anterior wall, prompting further investigation with echocardiography and stress testing., A 58-year-old male patient post-coronary artery bypass grafting (CABG) presents for a follow-up evaluation.A rest-stress PET scan (with code 78434) is ordered to assess the patency of the bypass grafts and the myocardial perfusion of the revascularized territories. The quantitative analysis demonstrates excellent perfusion in all segments, suggesting successful graft function.
* Patient demographics and medical history* Indications for the procedure* Type of stress testing used (pharmacologic agent and dose)* Radiopharmaceutical used (and dosage)* Imaging protocol* Quantitative analysis results (myocardial blood flow measurements)* Physician's interpretation of the findings* Final report including all relevant information.
** This code is frequently used in conjunction with codes for pharmacologic stress testing.Always review payer-specific guidelines for any additional coding requirements or limitations.
- Revenue Code: I1E (STANDARD IMAGING - NUCLEAR MEDICINE)
- RVU: This information is not available in the provided sources and would vary based on geographic location and payer.
- Global Days: Not applicable; this is an add-on code.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier is applicable to this code.The technical component is typically reported when a physician interprets images, while the professional component is billed separately for physician interpretation.
- Fee Schedule: Historical fee schedule information varies based on payer and location. Consult the most up-to-date fee schedule and relevant guidelines for more information.
- Specialties:Cardiology, Nuclear Cardiology, Radiology
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center