78451
Myocardial perfusion imaging, single study
Myocardial 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.
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.
Full guidance
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.