2025 CPT code 78481
(Active) Effective Date: N/A Revision Date: N/A Radiology - Nuclear Medicine Procedures Radiology Feed
Cardiac blood pool imaging (planar), first-pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification.
Modifiers 26 (professional component) and TC (technical component) may be applicable depending on the services rendered and payer guidelines.
Medical necessity for this test is typically established by symptoms suggestive of cardiac disease (chest pain, shortness of breath), prior history of cardiac events, or need for monitoring of heart function in patients with known cardiac conditions.Specific criteria for medical necessity may vary depending on payer requirements.
A nuclear medicine physician or qualified technologist administers the radiopharmaceutical and performs the imaging. A cardiologist or other physician specializing in cardiovascular care interprets the results and integrates them into patient management.
In simple words: This test uses a special camera and a small amount of radioactive material to create pictures of your heart's blood flow.It shows how well your heart is pumping blood, both when you are resting and potentially when you are exercising or have been given medication to stress your heart.
This CPT code 78481 represents a single cardiac blood pool imaging study using the first-pass technique.The imaging is performed either at rest or with stress induced by exercise or pharmacologic agents.The study includes an assessment of wall motion, ejection fraction, and may optionally include quantification. This is a planar imaging technique, not tomographic.
Example 1: A patient presents with chest pain and shortness of breath.A 78481 study is ordered to assess left ventricular function and determine if there is evidence of ischemia., A patient with known coronary artery disease undergoes a stress test with 78481 imaging to evaluate the effectiveness of medical therapy or revascularization., A patient with a history of heart failure is monitored using serial 78481 studies to assess response to treatment and progression of disease.
* Physician's order specifying the indication for the study.* Patient history and physical examination findings.* Results of any prior cardiac imaging studies.* Detailed report including wall motion scores, ejection fraction, and any quantitative data.* Images acquired during the study.
** This code should not be used if multiple studies at rest and with stress are performed. Use code 78483 instead in those circumstances.Always verify payer-specific guidelines for coverage and reimbursement.
- Revenue Code: I1E (STANDARD IMAGING - NUCLEAR MEDICINE)
- Payment Status: Active
- Modifier TC rule: Modifier TC may apply to the technical component, but payer policies may vary.
- Specialties:Cardiology, Nuclear Medicine
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Office