CPT 78492Radiology

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CPT 78492 covers PET (Positron Emission Tomography) imaging of the heart muscle performed under both rest and stress conditions to evaluate blood flow and detect coronary artery disease.

Showing rates for

National Average

Base Medicare rate

$79.90

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

1.8

PE RVU (NF)

0.62

MP RVU

0.05

Total RVU

2.47

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

NCCI bundling edits

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Billing tips

Verify that both rest AND stress components are documented in the interpretation report before billing 78492
Impact: Using 78492 for rest-only studies results in overpayment and potential fraud allegations; use 78491 instead, which reimburses differently
Document the specific radiopharmaceutical used (typically Rb-82 or N-13 ammonia) and dosage in medical record
Impact: Missing radiopharmaceutical documentation is a top audit trigger and can result in complete claim denial
Bill modifier 26 when hospital owns equipment but physician provides interpretation remotely or independently
Impact: Professional component represents approximately 25-30% of total allowable; incorrect modifier use leads to underpayment or overpayment
Separate radiopharmaceutical supply codes (A9555 for Rb-82, A9526 for N-13) must be billed in addition to 78492
Impact: Radiopharmaceutical costs are not included in 78492 payment; failing to bill separately results in significant lost revenue (often $1000+ per study)
Document stress method used (pharmacologic with regadenoson, adenosine, dipyridamole) including dosage and patient response
Impact: Inadequate stress protocol documentation is cited in 40% of PET cardiac denials according to recent audit data
Verify medical necessity with appropriate diagnosis codes (chest pain, CAD history, abnormal stress test) before performing study
Impact: National Coverage Determination requirements for cardiac PET are strict; non-covered indications result in 100% payment denial

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 78492 in 2025?

The 2025 Medicare national average payment for CPT 78492 is $79.90 for both facility and non-facility settings. This represents the professional interpretation component only and does not include the technical component or radiopharmaceutical costs, which are billed separately.

What is the difference between CPT 78491 and 78492?

CPT 78491 covers myocardial PET imaging at rest only (single study), while CPT 78492 requires both rest and stress imaging (multiple studies). You must document both components to bill 78492; billing 78492 for rest-only studies is incorrect coding and considered upcoding.

How many RVUs is CPT code 78492 worth?

CPT 78492 has a total of 2.47 RVUs in 2025, consisting of 1.8 work RVUs, 0.62 practice expense RVUs, and 0.05 malpractice RVUs. These values are the same for both facility and non-facility settings.

Can CPT 78492 be billed with modifier 26?

Yes, modifier 26 should be appended to 78492 when billing only the professional component (physician interpretation). This is common when a hospital or imaging center owns the equipment and bills the technical component separately with modifier TC.

What radiopharmaceutical codes are billed with 78492?

The most common radiopharmaceutical codes billed with 78492 are A9555 (Rubidium Rb-82) and A9526 (Nitrogen N-13 ammonia). These are billed separately as the radiopharmaceutical cost is not included in the 78492 reimbursement.

Does Medicare cover cardiac PET scans with CPT 78492?

Medicare covers CPT 78492 under National Coverage Determination 220.6 for specific indications including diagnosis of coronary artery disease in symptomatic patients, evaluation following inconclusive SPECT study, and assessment when other tests are contraindicated. Prior authorization may be required.

What documentation is required to bill CPT 78492 without denial?

Required documentation includes: signed interpretation report, evidence of both rest and stress image acquisition, specific stress agent and dosage, radiopharmaceutical type and dose, patient response to stress, quantitative perfusion analysis, comparison of rest vs stress findings, and medical necessity justification matching the diagnosis code.