2025 CPT code 78491
(Active) Effective Date: N/A Revision Date: N/A Radiology - Nuclear Medicine Procedures Cardiovascular System Feed
Positron emission tomography (PET) scan of the heart to assess blood flow, including ventricular wall motion and/or ejection fraction (if performed); single study at rest or during stress (exercise or pharmacologic).
Modifiers 26 (professional component), 52 (reduced services), TC (technical component), and others may apply depending on the specific circumstances of the procedure and payer guidelines.
Medical necessity is established by the presence of symptoms suggestive of coronary artery disease (e.g., chest pain, shortness of breath), risk factors for coronary artery disease, inconclusive results from other diagnostic tests, or the need to assess the effectiveness of current treatment.
A physician specializing in cardiology or nuclear medicine administers the radioactive tracer, operates the PET scanner, interprets the images, and prepares a report detailing the findings, including assessment of perfusion, ventricular wall motion, and ejection fraction (if performed).
In simple words: This heart test uses a special scanner (PET) and a small amount of radioactive material to create detailed pictures of how blood flows through your heart. The test might be done while you are resting or while exercising (or taking medicine to increase your heart rate).The results will show how well your heart is pumping and if there are any areas with poor blood flow.
Myocardial imaging using positron emission tomography (PET) to evaluate perfusion (blood flow) of the heart muscle. This involves injecting a radioactive tracer into the bloodstream, allowing the scanner to detect gamma rays emitted by the tracer and create three-dimensional images. The procedure may be performed at rest or during stress (exercise- or drug-induced).The code encompasses assessment of ventricular wall motion and/or ejection fraction if performed, but these are not separately billable as they are inclusive of the main procedure.A single study, either at rest or stress, is reported with this code.
Example 1: A 60-year-old male presents with chest pain and shortness of breath.A 78491 PET scan is performed at rest to evaluate for coronary artery disease.The results show reduced perfusion in the inferior wall, indicating potential ischemia., A 55-year-old female with a history of diabetes and hypertension undergoes a pharmacologic stress test with a 78491 PET scan.The stress images reveal significant perfusion defects in the anterior wall, suggesting significant coronary artery disease., A 70-year-old male with known coronary artery disease undergoes a follow-up 78491 PET scan at rest to assess the effectiveness of his current treatment.The results demonstrate improved perfusion compared to previous studies.
Patient demographics, history and physical exam, indication for the study, results of ECG or other relevant prior imaging studies, detailed description of the procedure performed (rest or stress, type of stress), images and interpretation report.
** This code should not be reported if both metabolic and perfusion evaluations are performed, as separate codes exist for these combined studies. The use of concurrent CT is addressed by other codes (78430).
- Revenue Code: I1E (STANDARD IMAGING - NUCLEAR MEDICINE)
- Payment Status: Active
- Modifier TC rule: Modifier TC may apply if only the technical component is performed and billed separately, but this is often not necessary in hospital settings.
- Specialties:Cardiology, Nuclear Medicine, Radiology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center