CPT 78454Radiology

Ht musc image planar mult

CPT code 78454 covers a nuclear medicine imaging procedure that takes multiple planar (flat, two-dimensional) pictures of the heart muscle to assess blood flow and heart function. This differs from 3D imaging and involves taking pictures from different angles at rest or during stress.

Showing rates for

National Average

Base Medicare rate

$378.78

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

1.34

PE RVU (NF)

10.25

MP RVU

0.12

Total RVU

11.71

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

NCCI bundling edits

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Billing tips

Verify whether rest, stress, or both protocols were performed before code selection. If only single-study planar imaging was performed, use 78451-78453 instead of 78454 to avoid downcoding.
Impact: Incorrect code selection results in $50-150 underpayment or claim denial with 15-30 day payment delay
Document the specific number of planar views obtained and imaging angles in the report. Medicare requires multiple views from different projections to support 78454.
Impact: Insufficient view documentation leads to 23% denial rate with downcoding to single-view codes, reducing reimbursement by approximately $75-100
Bill 78454 as a global service (no modifier) in non-facility settings where your practice owns the equipment and employs the interpreting physician. Split billing with 26/TC only when services are actually performed at different locations.
Impact: Improper modifier use can result in $100-150 underpayment if global service is split unnecessarily
Separately bill the stress agent administration (e.g., A9502 for Technetium Tc-99m tetrofosmin, A9500 for Tc-99m sestamibi) and stress testing procedures (93015-93018) when applicable, as these are not bundled with 78454.
Impact: Failure to bill radiopharmaceuticals results in $150-400 revenue loss per study; stress test codes add $25-75
Ensure attenuation correction, if performed, is documented but understand it is included in 78454 payment. Do not separately bill attenuation correction procedures.
Impact: Unbundling attenuation correction results in automatic denial and potential audit trigger
When both planar and SPECT imaging are performed on the same patient, bill only the SPECT code (78464 or 78465) as it is the more comprehensive study and includes planar images.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78454 in 2025?

The 2025 Medicare national average reimbursement for CPT 78454 is $378.78 for both facility and non-facility settings, based on 11.71 total RVUs and the 2025 conversion factor of 32.3465.

What is the difference between CPT 78454 and 78451?

CPT 78451 represents a single planar myocardial perfusion study (either rest or stress only), while 78454 indicates multiple studies (typically both rest and stress imaging). Code selection depends on the number of separate imaging sessions performed, with 78454 reimbursing at a higher rate for the more comprehensive evaluation.

Can you bill CPT 78454 and 78465 together?

No, CPT 78454 (planar) and 78465 (SPECT) should not be billed together for the same study. SPECT imaging is more comprehensive and includes planar views, so only the SPECT code should be reported. Billing both together violates NCCI edits and will result in denial of the planar code.

How many RVUs is CPT code 78454 worth?

CPT 78454 has 11.71 total RVUs in 2025, consisting of 1.34 work RVUs, 10.25 practice expense RVUs, and 0.12 malpractice RVUs. The PE RVU is the same (10.25) for both facility and non-facility settings.

What diagnosis codes support medical necessity for CPT 78454?

Common supporting diagnosis codes include I25.10-I25.119 (atherosclerotic heart disease), I20.0-I20.9 (angina pectoris), R07.89 (chest pain), I50.9 (heart failure), and Z95.1-Z95.5 (presence of cardiac implants/grafts). Pre-operative evaluation codes (Z01.810-Z01.818) may support coverage when assessing cardiac risk before major surgery in high-risk patients.

Does CPT 78454 include the radiopharmaceutical cost?

No, the radiopharmaceutical is billed separately using HCPCS codes such as A9502 (Technetium Tc-99m tetrofosmin) or A9500 (Tc-99m sestamibi). The 78454 reimbursement covers the technical performance of imaging and professional interpretation only, not the radiotracer itself.

When should I use modifier 26 with CPT 78454?

Use modifier 26 when billing only the professional component (physician interpretation) because the imaging was performed at a facility you don't own, such as a hospital or independent imaging center. The facility bills the technical component (TC modifier) separately. If your practice performs both the imaging and interpretation, bill 78454 without modifiers as a global service.