Myocardial perfusion imaging, tomographic (SPECT), multiple studies (rest and stress) (exercise or pharmacologic); with or without wall motion, qualitative or quantitative wall motion, ejection fraction and/or first pass
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Myocardial perfusion imaging medical necessity not met or stress test not appropriate
Very Common78452 (myocardial perfusion imaging, nuclear stress test) requires cardiac symptoms or high cardiac risk. Denied when asymptomatic screening without risk factors, when stress ECG (93015) more appropriate first test, when recent normal study without symptom change, or when patient unable to exercise and pharmacologic stress not justified. Pre-operative screening only for high-risk surgery in high-risk patients.
Common Causes
- • Asymptomatic screening - insurance doesn't cover screening nuclear studies in low-risk patients
- • Atypical chest pain, low pre-test probability - simple stress ECG first, reserve nuclear for abnormal ECG or unable to exercise
- • Recent normal nuclear stress (within 2 years) - repeat not indicated without new symptoms
Resolution Strategy
Document cardiac symptoms or high risk: 'Patient with 3 months of exertional chest pressure, relieved by rest, concerning for angina. Unable to perform exercise stress test due to severe osteoarthritis limiting walking. Pharmacologic stress myocardial perfusion imaging ordered (regadenoson protocol). Nuclear imaging necessary to assess for inducible ischemia in patient unable to exercise. Results will guide need for cardiac catheterization.' Alternative: 'Patient with known CAD, prior stent 3 years ago, presenting with recurrent exertional dyspnea. Prior nuclear stress 3 years ago. New symptoms warrant repeat evaluation to assess for ischemia and guide management.' Must document: cardiac symptoms, why nuclear preferred over ECG stress, why patient can't exercise if pharmacologic stress. Pre-op only for high-risk surgery (vascular, major abdominal) in high-risk patients. Cannot appeal asymptomatic screening.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For myocardial perfusion SPECT imaging, multiple studies (rest and stress)
Common Scenarios
Documentation Requirements
- Indication for myocardial perfusion imaging
- Type of stress used (exercise vs pharmacologic)
- Rest and stress myocardial perfusion findings
- Wall motion assessment
- Ejection fraction if performed
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes multiple studies (rest and stress)
- Includes SPECT imaging
- Wall motion assessment bundled
- Ejection fraction bundled
- Single study coded separately
Exclusions
- 78451 (myocardial perfusion imaging, SPECT, single study)
- 78453 (myocardial perfusion imaging, planar, single study)
- 78454 (myocardial perfusion imaging, planar, multiple studies)
- 93015 (cardiovascular stress test)
Coding Notes
Clinical scenarios
- Indication for myocardial perfusion imaging
- Type of stress used (exercise vs pharmacologic)
- Rest and stress myocardial perfusion findings
- Indication for myocardial perfusion imaging
- Type of stress used (exercise vs pharmacologic)
- Rest and stress myocardial perfusion findings
- Indication for myocardial perfusion imaging
- Type of stress used (exercise vs pharmacologic)
- Rest and stress myocardial perfusion findings
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 78452 is the billing code for "Myocardial perfusion imaging, tomographic (SPECT), multiple studies (rest and stress) (exercise or pharmacologic); with or without wall motion, qualitative or quantitative wall motion, ejection fraction and/or first pass". For myocardial perfusion SPECT imaging, multiple studies (rest and stress)
Medicare pays approximately $408.86 for CPT 78452 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 78452 has a total RVU of 19.12, broken down as: Work RVU 4.20, Practice Expense RVU 14.50, and Malpractice RVU 0.42. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 78452 is "Myocardial perfusion imaging medical necessity not met or stress test not appropriate". 78452 (myocardial perfusion imaging, nuclear stress test) requires cardiac symptoms or high cardiac risk. Denied when asymptomatic screening without risk factors, when stress ECG (93015) more appropriate first test, when recent normal study without symptom change, or when patient unable to exercise and pharmacologic stress not justified. Pre-operative screening only for high-risk surgery in high-risk patients. Common causes include: Asymptomatic screening - insurance doesn't cover screening nuclear studies in low-risk patients; Atypical chest pain, low pre-test probability - simple stress ECG first, reserve nuclear for abnormal ECG or unable to exercise. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 78452 include: Indication for myocardial perfusion imaging; Type of stress used (exercise vs pharmacologic); Rest and stress myocardial perfusion findings; Wall motion assessment. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 78452: Includes multiple studies (rest and stress). Includes SPECT imaging Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 78452 include: 26 (Professional component only (interpretation)), TC (Technical component only (equipment/staff)), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 78452 is 60-90 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.