CPT 78429Radiology

Myocrd img pet 1 std w/ct

CPT code 78429 covers a specialized heart imaging test called myocardial PET (positron emission tomography) combined with CT scanning, using one standard imaging agent to assess blood flow and heart muscle health.

Showing rates for

National Average

Base Medicare rate

$75.69

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.76

PE RVU (NF)

0.53

MP RVU

0.05

Total RVU

2.34

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill 78429 only for single study (rest OR stress); combined rest/stress studies require different code 78431 or 78432
Impact: Prevents upcoding denials and ensures correct reimbursement; improper code selection can result in 100% claim denial
Verify that CT attenuation correction is documented in report; without CT component, code 78459 is appropriate instead
Impact: Code 78429 specifically includes CT component; missing documentation may trigger downcoding to lower-paying code
Confirm radiotracer used and administration is separately billable under HCPCS codes (e.g., A9555 for Rubidium-82)
Impact: Radiopharmaceutical costs can exceed $1,000 per study; failing to bill separately results in significant revenue loss
Document medical necessity with specific indication beyond 'chest pain'; include prior test results and clinical decision-making
Impact: Medicare LCD policies require specific indications; vague documentation increases denial rate by approximately 25-30%
Check National Coverage Determination (NCD) 220.6 requirements for PET myocardial perfusion imaging before billing
Impact: Non-compliance with NCD criteria results in automatic denial; appeals are rarely successful without meeting coverage requirements
Use modifier 26 or TC appropriately based on split billing arrangements; never bill global code when components are split
Impact: Incorrect modifier use triggers overpayment recovery; facility and professional claims combined should equal $75.69 total

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78429 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 78429 is $75.69 for both facility and non-facility settings, based on a total RVU of 2.34 and conversion factor of 32.3465.

What is the difference between CPT 78429 and 78431?

CPT 78429 represents a single myocardial PET study (rest OR stress only) with CT, while 78431 includes multiple studies typically performed as rest and stress imaging in sequence. Code 78431 provides more comprehensive cardiac assessment and has higher reimbursement.

Can CPT 78429 be billed with an echocardiogram on the same day?

Yes, but modifier 59 may be required to indicate distinct procedural services. Documentation must clearly support separate medical necessity for both studies and demonstrate that each answered different diagnostic questions not adequately addressed by the other modality.

What radiotracers are used with CPT 78429?

Common radiotracers include Rubidium-82 (HCPCS A9555) and N-13 ammonia (HCPCS A9526). These radiopharmaceuticals are billed separately from the CPT 78429 professional and technical service codes.

Does CPT 78429 require prior authorization for Medicare?

Prior authorization requirements vary by MAC (Medicare Administrative Contractor) jurisdiction. Many MACs require prior authorization for advanced cardiac imaging including PET studies, particularly when ordered for non-specific indications or without prior non-invasive testing.

How many RVUs is CPT 78429 worth in 2025?

CPT 78429 has a total RVU value of 2.34 in 2025, composed of 1.76 work RVUs, 0.53 practice expense RVUs, and 0.05 malpractice RVUs. These values are identical for both facility and non-facility settings.

What documentation is needed to support medical necessity for CPT 78429?

Required documentation includes specific cardiac symptoms or clinical indication, prior diagnostic testing results, cardiovascular risk factors, written physician order, and explanation of how PET/CT results will impact treatment decisions. Generic indications like 'chest pain' are insufficient without additional clinical context.