2025 CPT code 78459
(Active) Effective Date: N/A Revision Date: N/A Radiology - Nuclear Medicine Procedures Radiology Feed
Myocardial imaging using positron emission tomography (PET) to assess heart metabolism (including ventricular wall motion and/or ejection fraction, if performed); single study.
Modifiers 26 (professional component) and TC (technical component) may be appended as appropriate, depending on payer policies and the services provided.
Medical necessity for a PET myocardial perfusion scan (78459) is established by the presence of symptoms suggestive of coronary artery disease, prior MI, or heart failure.It is used to assess myocardial viability and perfusion, and guide treatment decisions.
The physician injects the radioactive tracer, operates the PET scanner, analyzes the images, and interprets the results to assess the patient's cardiac function and metabolism.This includes evaluation of ventricular wall motion and ejection fraction, as appropriate. A report is generated documenting the findings and conclusions.
In simple words: This is a heart scan using a special type of imaging called PET. A small amount of radioactive material is injected to show how well the heart is using energy. The doctor may also check how well the heart is pumping blood. This code is for one scan.
This CPT code encompasses a single myocardial perfusion imaging study using positron emission tomography (PET). The procedure involves the administration of a radioactive tracer, followed by image acquisition to evaluate myocardial metabolism.The study may include assessment of ventricular wall motion and ejection fraction, if performed.The code does not include the cost of the radiopharmaceutical.
Example 1: A patient presents with chest pain and suspected coronary artery disease. A PET myocardial perfusion scan (78459) is performed to assess myocardial viability and perfusion, aiding in the diagnosis and management of CAD.Stress testing (93015-93018) may be added if performed., A patient with known heart failure undergoes a PET scan (78459) to evaluate myocardial metabolism and assess the effectiveness of current treatment.Ventricular wall motion and ejection fraction are assessed., A patient post-myocardial infarction undergoes a PET scan (78459) to determine the extent of myocardial damage and guide post-MI management.The scan assesses the extent of viable and non-viable myocardial tissue.
* Patient's medical history, including symptoms, risk factors, and prior cardiac events.* Details of the procedure, including the type of radiopharmaceutical used, the imaging protocol, and any stress testing performed.* Images from the PET scan.* Physician's interpretation of the images, including assessment of myocardial perfusion, ventricular wall motion, and ejection fraction.* Diagnostic report with comprehensive findings and clinical correlations.
** The code 78459 describes a metabolic evaluation study.If the focus is solely on perfusion, code 78491 might be more appropriate.Always refer to the latest CPT manual for the most up-to-date information and coding guidelines.
- Revenue Code: I1E (STANDARD IMAGING - NUCLEAR MEDICINE)
- Payment Status: Active
- Modifier TC rule: Modifier TC (Technical Component) may be applicable if only the technical aspect of the procedure (image acquisition and processing) is billed separately.
- Specialties:Cardiology, Nuclear Medicine, Radiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center