78451
RadiologyCMS status: AMyocardial perfusion imaging (MPI), single study, single rest or stress, planar or SPECT. CMS 2026 global wRVU 1.46, total RVU approximately 6.06, Medicare global allowable approximately $202. The cardiac perfusion test used to assess ischemia, viability, and myocardial blood flow.
Drop 78451 into a scenario to see how unit volume rolls up to annual wRVUs, gross collections, and bonus.
Open in calculator →When to use it
Use 78451 when a single MPI study (rest only OR stress only) is performed. 78452 (multiple studies) is the standard for the workhorse rest-and-stress combination — the most common MPI workflow. 78453 / 78454 are planar (now rare) versions. Pair with stress test supervision and interpretation (93016 supervision, 93018 interpretation) when a treadmill or pharmacologic stress is performed in your facility.
Documentation checklist
- ✓Order with indication (chest pain workup, abnormal stress EKG, known CAD surveillance).
- ✓Stress protocol documented (treadmill, dobutamine, regadenoson, adenosine).
- ✓Radiotracer name and dose (Tc-99m sestamibi, Tc-99m tetrofosmin, Tl-201).
- ✓Image acquisition parameters and reconstruction details.
- ✓Interpretation: rest and/or stress perfusion findings, EF if gated, regional wall motion, comparison to prior.
- ✓Setting modifier; signed report.
Common pitfalls
- !Billing 78451 when a rest-and-stress study was actually performed. The correct code for both phases is 78452.
- !Failing to bill the stress component (93015 / 93016 / 93018) separately. The MPI and the stress test are different services and bill separately.
- !Missing the radiotracer dose documentation. Radiopharmaceutical billing (A-codes) is separate from the MPI procedure code.
- !Confusing 78451 / 78452 with the older planar codes 78453 / 78454. Most modern MPI is SPECT, billed as 78451 / 78452.
- !Billing 78451 with 93350 (stress echo) on the same encounter for the same patient. Choose the appropriate stress imaging modality; not both.
Payer notes
Medicare covers 78451 / 78452 with appropriate indication. Outpatient prior authorization is common for commercial payers; ED studies are usually post-care approved. Appropriate-use criteria (AUC) from ACC/SCCT apply: payers may deny when imaging is ordered for low-risk asymptomatic patients without abnormal stress EKG.