CPT 78430Radiology

Myocrd img pet rst/strs w/ct

CPT 78430 covers cardiac PET imaging that shows blood flow to the heart muscle both at rest and during stress, combined with a CT scan. This advanced imaging helps doctors diagnose coronary artery disease and assess heart function.

Showing rates for

National Average

Base Medicare rate

$71.49

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

1.67

PE RVU (NF)

0.5

MP RVU

0.04

Total RVU

2.21

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

NCCI bundling edits

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Billing tips

Bill global code without modifiers when performing both technical and professional components in same facility
Impact: Ensures full $71.49 reimbursement rather than split component payments which may total less
Document radiotracer type, dose, administration time, and lot number for each injection (rest and stress)
Impact: Prevents denials for inadequate documentation; required for quality measures and audit defense
Clearly document stress protocol type (pharmacologic agent/dose or exercise protocol) and patient response including vital signs
Impact: Medical necessity requirement; missing stress documentation triggers 15-20% denial rate for this code
Verify pre-authorization for Medicare Advantage and commercial payers before scheduling; many require prior auth for cardiac PET
Impact: Prevents write-offs averaging $400-800 per study for lack of authorization
Bill separately for stress agent administration (e.g., A9505 for rubidium-82) using appropriate HCPCS codes with documented waste
Impact: Recovers additional $200-600 in radiotracer costs not included in CPT 78430 technical component
Include attenuation correction documentation and CT parameters in report; this distinguishes from non-CT PET codes
Impact: Supports correct code selection and prevents downcoding to 78459 (without CT), which may reimburse differently

Applicable modifiers

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Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT 78430?

The 2025 Medicare national average reimbursement for CPT 78430 is $71.49 for both facility and non-facility settings, based on 2.21 total RVUs and a conversion factor of 32.3465.

Does CPT 78430 include both the rest and stress portions of cardiac PET imaging?

Yes, CPT 78430 is a complete code that includes myocardial perfusion imaging at both rest and stress with CT attenuation correction. If only rest imaging is performed, modifier 52 should be appended and reimbursement will be reduced.

What is the difference between CPT 78430 and 78431?

CPT 78430 includes both rest and stress imaging with CT, while 78431 includes multiple studies performed on the same day (rest, stress, and additional redistribution or rest reinjection images). Use 78431 when protocol requires more than standard rest/stress acquisition.

Can I bill CPT 78430 and a cardiac catheterization on the same day?

Yes, but documentation must clearly show distinct clinical indications and separate sessions. Modifier 59 may be required to override bundling edits. Many payers scrutinize this combination and may deny without compelling medical necessity for both procedures on the same date.

What radiotracers are appropriate for billing CPT 78430?

CPT 78430 is appropriate for PET perfusion tracers including rubidium-82 (Rb-82) and nitrogen-13 ammonia (N-13 NH3). The radiotracer cost is billed separately using HCPCS codes (A9555 for Rb-82, A9526 for N-13 ammonia) and is not included in the CPT 78430 reimbursement.

Do I need prior authorization for CPT 78430?

Medicare Part B typically does not require prior authorization for CPT 78430, but Medicare Advantage plans and most commercial payers do require pre-authorization. Verify with specific payer before scheduling as unauthorized studies frequently result in complete payment denial.

How should I bill CPT 78430 when only the professional or technical component is provided?

Use modifier 26 for professional component only (physician interpretation) or modifier TC for technical component only (equipment, staff, radiotracer administration). Split billing is common when interpreting physicians are not employed by the imaging facility. The sum of split components may differ from global reimbursement.