CPT 78432Radiology

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CPT code 78432 covers a specialized heart imaging procedure using PET scan technology with two or more radioactive tracers to evaluate blood flow and heart muscle viability. This advanced cardiac imaging helps doctors determine if damaged heart tissue can recover with treatment.

Showing rates for

National Average

Base Medicare rate

$92.19

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

2.07

PE RVU (NF)

0.71

MP RVU

0.07

Total RVU

2.85

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

NCCI bundling edits

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Billing tips

Verify LCD coverage criteria before scheduling - most Medicare contractors require specific indications such as evaluation for revascularization in patients with prior MI and reduced EF, or assessment of viability in heart failure patients
Impact: Prevents denials; cardiac PET viability studies have approximately 15-20% denial rate when medical necessity not clearly documented
Document both tracers used with administration times, doses, and specific protocols - the code requires two or more tracers and documentation must support this
Impact: Single-tracer studies should use 78459 ($92.19 vs appropriate single-tracer code); improper coding risks downcoding and potential audit
Submit stress test component separately if pharmacologic stress is performed - use appropriate pharmacologic stress code (93015-93018) in addition to imaging code
Impact: Pharmacologic stress administration is separately billable and typically adds $50-150 to total reimbursement depending on protocol
Include specific clinical indication linking to revascularization decision-making or viability assessment in documentation - generic 'chest pain' or 'CAD' insufficient for most LCDs
Impact: Strengthens medical necessity; vague indications account for 30-40% of cardiac PET denials on review
Bill facility and professional components separately in hospital setting - verify split with facility to avoid duplicate billing or lost revenue
Impact: Professional component alone is worth approximately $36-42 based on work RVU distribution; ensure both components are captured
Check for ABN requirements when coverage uncertain - cardiac PET may not be covered for all indications and some LCDs have specific limitations

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Frequently asked questions

What is the Medicare reimbursement for CPT code 78432 in 2025?

The 2025 Medicare national average payment rate for CPT 78432 is $92.19 for both facility and non-facility settings. This represents the total reimbursement when billing the complete service globally. The rate is based on 2.85 total RVUs multiplied by the 2025 conversion factor of $32.3465.

What is the difference between CPT 78432 and 78459 for cardiac PET imaging?

CPT 78432 specifically requires myocardial PET imaging with two or more tracers (dual-tracer protocol), typically combining perfusion and metabolic tracers for viability assessment. CPT 78459 is used for single-tracer myocardial PET perfusion imaging. The dual-tracer approach (78432) is primarily used for viability assessment in patients being considered for revascularization, while single-tracer studies (78459) are used for perfusion assessment only.

Does CPT 78432 include the pharmacologic stress test administration?

No, CPT 78432 includes only the imaging component and interpretation. If pharmacologic stress is performed (such as with regadenoson, adenosine, or dipyridamole), the stress administration should be billed separately using the appropriate cardiovascular stress test code (93015-93018). The stress test code captures the drug administration, monitoring, and physician supervision during the stress portion.

What are the typical medical necessity criteria for billing 78432?

Most Medicare LCDs require specific indications including: assessment of myocardial viability in patients with prior infarction and reduced left ventricular function being considered for revascularization; distinguishing hibernating myocardium from scar tissue; or evaluating candidacy for advanced heart failure therapies. Generally requires documented coronary artery disease, reduced ejection fraction (typically <40%), and a pending revascularization decision. Generic screening or routine CAD evaluation typically does not meet medical necessity criteria.

Can CPT 78432 be billed with modifier 26 for professional component only?

Yes, in hospital or facility settings where the institution owns the PET scanner and provides technical services, the interpreting physician bills CPT 78432-26 for professional component only (interpretation and report). The facility bills 78432-TC for the technical component. The professional component work RVU is 2.07 out of 2.85 total, representing approximately 40-45% of the total payment.

What tracers are typically used for CPT code 78432 dual-tracer protocols?

The most common dual-tracer protocol combines a perfusion tracer (rubidium-82 or N-13 ammonia) with F-18 FDG (fluorodeoxyglucose) for metabolic imaging. The perfusion tracer assesses blood flow while FDG uptake indicates viable myocardium with preserved glucose metabolism. Some protocols may use other combinations, but the perfusion/metabolism pairing is standard for viability assessment. Documentation must clearly identify both tracers used with separate administration times.

How often can CPT 78432 be billed for the same patient?

Medicare and most commercial payers have frequency limitations, typically allowing cardiac PET viability studies once per year or less frequently unless there is documented change in clinical status. Repeat studies within short timeframes require strong clinical justification such as interval acute coronary event, failed revascularization, or significantly changed clinical status affecting treatment decisions. Medical necessity for repeat studies within 12 months should be clearly documented with specific clinical rationale, and modifier 76 or 77 may be required for same-day repeats.