CPT 78433Radiology

Myocrd img pet 2rtracer ct

CPT code 78433 covers a specialized heart imaging test that uses PET scanning with two different radioactive tracers combined with a CT scan to evaluate blood flow and metabolism in the heart muscle.

Showing rates for

National Average

Base Medicare rate

$98.33

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

2.26

PE RVU (NF)

0.71

MP RVU

0.07

Total RVU

3.04

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

NCCI bundling edits

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Billing tips

Document both radiopharmaceutical tracers explicitly in the medical record with administration times, doses, and specific agents used (e.g., Rb-82 for perfusion plus F-18 FDG for viability)
Impact: Critical for audit defense - single tracer studies should be coded differently (78431/78432); failure to document dual-tracer protocol can result in downcoding and $30-50 payment reduction
Verify that CT attenuation correction images are acquired and documented as part of the study protocol
Impact: CT component is integral to code 78433; absence of CT documentation may trigger denial or require coding to non-CT variant with different reimbursement
Bill global code (78433) without modifiers when practice owns equipment and physician provides interpretation in same entity
Impact: Captures full $98.33 payment; inappropriate modifier use can fragment payment and reduce total reimbursement by 15-40%
Ensure medical necessity documentation includes specific indication for dual-tracer protocol rather than single-tracer study
Impact: Medicare and payers increasingly scrutinize dual-tracer necessity; inadequate justification can lead to denial and requirement to refund difference between codes (approximately $40-60)
Submit claims with appropriate ICD-10 codes supporting viability assessment (I25.5, I25.10, I50.x series) rather than simple screening codes
Impact: Proper diagnosis coding improves first-pass acceptance rate by 25-30% and reduces medical review requests
Do not unbundle radiopharmaceutical supply codes (A9555 for Rb-82, A9552 for F-18 FDG) from 78433 when billing Medicare

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78433 in 2025?

The 2025 Medicare national average reimbursement for CPT 78433 is $98.33 for both facility and non-facility settings. This rate is based on 3.04 total RVUs multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 78433 and 78431 or 78432?

CPT 78433 specifically requires two different radiopharmaceutical tracers (dual-tracer protocol) with CT, while 78431 and 78432 involve single-tracer protocols. Code 78431 is a single-tracer study with CT for attenuation correction, and 78432 is a single-tracer study with CT and concurrent transmission/emission scans. The dual-tracer protocol in 78433 typically combines perfusion assessment with viability or metabolic imaging.

How many RVUs is CPT code 78433 worth?

CPT 78433 has a total of 3.04 RVUs in 2025, consisting of 2.26 work RVUs, 0.71 practice expense RVUs (both facility and non-facility), and 0.07 malpractice RVUs.

Can CPT 78433 be billed with modifier 26 for professional component only?

Yes, modifier 26 can be appended to 78433 when billing only the professional component (physician interpretation). This is appropriate when the technical component (equipment, tracers, technologist) is provided by a separate entity such as a hospital. The facility would then bill the technical component using modifier TC.

What diagnoses support medical necessity for CPT 78433?

Common supporting diagnoses include coronary artery disease with reduced ejection fraction (I25.5), chronic ischemic heart disease (I25.10), heart failure (I50.x series), viable myocardium evaluation pre-revascularization, and assessment of mixed perfusion/viability abnormalities. The key is documenting why dual-tracer imaging provides clinically necessary information beyond single-tracer studies.

How often can CPT 78433 be billed for the same patient?

There is no specific Medicare frequency limitation for 78433, but repeat studies within short time frames require strong clinical justification such as acute coronary events, post-revascularization complications, or significant change in clinical status. Most payers expect intervals of at least 3-6 months between routine follow-up studies unless intervening events warrant earlier imaging.

What radiopharmaceuticals are typically used for CPT 78433 dual-tracer protocols?

Common dual-tracer combinations include Rubidium-82 (Rb-82) for perfusion assessment paired with F-18 fluorodeoxyglucose (FDG) for metabolic/viability imaging, or Nitrogen-13 ammonia for perfusion with F-18 FDG for viability. The specific tracers must be documented in the medical record, and both must be administered as part of the same study session to justify code 78433.