Myocardial perfusion imaging, planar, multiple studies (rest and stress) (exercise or pharmacologic); with or without wall motion, qualitative or quantitative wall motion, ejection fraction and/or first pass

CPT 78454 is the billing code for "Myocardial perfusion imaging, planar, 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 planar imaging, multiple studies (rest and stress)

Medicare pays approximately $378.78 for CPT 78454 (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 78454 has a total RVU of 16.65, broken down as: Work RVU 3.50, Practice Expense RVU 12.80, and Malpractice RVU 0.35. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 78454 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 78454: Includes multiple studies (rest and stress). Includes planar imaging Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 78454 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 78454 is 50-80 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.