2025 CPT code 78431
(Active) Effective Date: N/A Revision Date: N/A Cardiology - Myocardial Perfusion Imaging Radiology Procedures > Nuclear Medicine Procedures Feed
Myocardial perfusion imaging using PET with multiple studies (rest and stress) and concurrent CT.
Modifiers 26 (professional component), TC (technical component), and others may apply depending on the specific services performed and the billing entity. Consult the most current CPT guidelines for modifier use.
Medical necessity for a myocardial perfusion PET/CT scan is established based on the patient's clinical presentation, risk factors, and history, to evaluate myocardial perfusion and detect coronary artery disease. The appropriate documentation demonstrating medical necessity must be provided to comply with payer guidelines.
A physician specializing in nuclear cardiology or cardiology is responsible for performing this procedure and interpreting the results. The clinical responsibility may also include ordering the test, administering the radiopharmaceutical, performing the stress test (if applicable), and providing patient follow-up and care.
In simple words: This test uses a special camera (PET) to take pictures of your heart's blood flow, both when you're at rest and when your heart is working harder.It also uses a CT scan to get better images of your heart. This helps doctors see if there are any problems with your heart muscle.
This CPT code encompasses myocardial perfusion imaging using positron emission tomography (PET), including multiple studies at rest and under stress (either exercise or pharmacologic).The procedure incorporates a concurrently acquired computed tomography (CT) transmission scan for attenuation correction and anatomical localization.Ventricular wall motion and ejection fraction are included when performed.
Example 1: A 65-year-old male with chest pain undergoes a myocardial perfusion PET/CT (code 78431) with pharmacologic stress testing using adenosine to evaluate for coronary artery disease.Multiple images are acquired at rest and after stress, to compare blood flow to the heart muscle., A 70-year-old female with history of hypertension and diabetes is assessed for myocardial viability using a combined PET/CT perfusion study (code 78431) with dobutamine stress testing. The multiple images at rest and during stress allow for thorough evaluation of blood flow and viability., A 58-year-old male with known coronary artery disease after a recent myocardial infarction is scheduled for a PET/CT scan (code 78431) to assess perfusion defects and guide potential revascularization procedures.Rest and stress images are acquired to compare myocardial blood flow patterns.
* Complete patient history and physical examination relevant to the indication for myocardial perfusion imaging.* Indication for the study and reason for choosing PET/CT imaging.* Details of any pre-medications or concurrent medications.* Type of stress test (exercise or pharmacologic) performed, including details of the stress protocol.* Radiopharmaceutical used and its dosage.* Results of the imaging study, including quantitative data if available.* Interpretation of the results and clinical correlations.* Relevant diagnostic and procedural reports.
** Accurate coding requires careful consideration of the specific services provided and the context of care. The information provided here is for general guidance only and does not replace professional coding expertise or consultation with the appropriate coding resources.
- Revenue Code: I1E (STANDARD IMAGING - NUCLEAR MEDICINE)
- RVU: This will vary depending on the payer and geographic location. Consult a fee schedule for specific RVU values and reimbursement rates.
- Global Days: The global period will vary depending on payer policy.Refer to your specific payer's guidelines.Generally, there is no global period associated with this test, but this needs to be verified.
- Payment Status: Active
- Modifier TC rule: Modifier TC (Technical Component) may apply if only the technical component of the service is reported.The application of this modifier will vary based on payer policy.
- Fee Schedule: Historical fee schedule data can be obtained through various sources, such as CMS, commercial payers, and private data providers.These data vary by region, payer, and year.
- Specialties:Cardiology, Nuclear Cardiology, Radiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center