CPT 78452: Myocardial Perfusion Imaging, SPECT, Multiple Studies

CPT 78452 covers tomographic myocardial perfusion imaging with multiple studies at rest and stress. It is one of the few places in cardiology where the stress test codes remain separately reportable, and practices that assume otherwise leave money on every nuclear study.

What CPT 78452 covers

78452 is myocardial perfusion imaging, tomographic (SPECT), multiple studies at rest and/or stress, including attenuation correction, qualitative or quantitative wall motion and ejection fraction by first pass or gated technique, and additional quantification when performed.

A great deal is bundled into the imaging code: attenuation correction, wall motion, ejection fraction and quantification are all inside it. Its single-study counterpart is 78451.

What stays separately reportable

Two things sit outside 78452 and are routinely under-billed:

• The stress test. 78452 pays for imaging, not for the stress test. The appropriate code from the 93015 family is separately reportable according to who supervised, who acquired the tracing and who interpreted it. This is the opposite of the stress echocardiography rule, where 93351 absorbs the stress test.
• The radiopharmaceutical. The tracer is supplied and billed separately under its own HCPCS code, subject to setting and payer rules.

Reimbursement context

78452 splits into professional and technical components, with the technical side carrying the equipment and radiopharmaceutical handling cost.

2026 Medicare RVUs for CPT 78452

Source: CMS CY 2026 PFS Relative Value File, RVU26D (October release, published 08/26/2026). RVUs are national and unadjusted; commercial payers set their own rates.

In the 2026 CMS relative value file, CPT 78452 carries 1.58 work RVUs and 12.81 total RVUs when billed globally in a non-facility setting. The global line is NA in a facility, because there the physician bills the professional component only and the facility bills the technical side. Its PC/TC indicator is 1: the code splits into a professional component (modifier 26, 2.23 total RVUs) and a technical component (modifier TC, 10.58 total RVUs), and the global line is billed only when one entity does both. Its global indicator is XXX: the surgical global period concept does not apply.

To turn RVUs into payment, each component is multiplied by your locality's geographic practice cost index, the three are added, and the sum is multiplied by the 2026 conversion factor: $33.4009, or $33.5675 for qualifying APM participants (CMS-1832-F; CMS fact sheet). The CMS Physician Fee Schedule Look-Up Tool runs that calculation for your locality.

Documentation requirements

• The cardiac indication justifying a nuclear perfusion study rather than a less intensive test.
• The stress method used, including agent and dose where pharmacological, and the reason for termination.
• The radiopharmaceutical, dose and administration route.
• Rest and stress image sets, both addressed in the report.
• Perfusion findings by territory, with defect size, severity and reversibility.
• Ejection fraction and wall motion, with the method used.
• Whether attenuation correction was applied.
• A signed interpretation with a conclusion answering the clinical question.

Medicare contractor billing articles. Each Medicare Administrative Contractor publishes its own billing and coding articles for this service, and the covered diagnoses differ by jurisdiction. Active examples in the CMS Medicare Coverage Database, checked September 28, 2026: A56743 (Cardiovascular Nuclear Medicine, Wellpoint Federal) and A56494 (Cardiovascular Nuclear Medicine, CGS). Use the article from the contractor that processes your claims.

Common denials and the exact fix

Modifier rules

• 26 / TC: applies where the professional and technical components are billed by different entities. Match the modifier to the billing entity, the place of service and equipment ownership.
• 59 / XE / XP / XS / XU: only for genuinely distinct services, never as a way past a frequency or bundling edit.
• 76 / 77: repeat study by the same or another physician, with a documented clinical trigger.
• 25: on the E/M where a separately identifiable visit occurred, never on the diagnostic code.
• GA / GY / GZ: where an advance beneficiary notice applies or a service is excluded, per payer instruction.

NCCI bundling edits

• 78452 with 93015 to 93018: separately reportable. The nuclear code covers imaging, not the stress test.
• 78452 with 78451: mutually exclusive. Report the code matching the number of studies performed.
• 78452 with separate wall motion, ejection fraction or attenuation correction lines: all are included.
• Radiopharmaceutical: reported separately under its own HCPCS code.
• 78452 with a same-day resting echo: different service, but confirm the indication supports both.

Frequently asked questions

Sources

American Medical Association, CPT 2026 Professional Edition.
Centers for Medicare & Medicaid Services, CY 2026 PFS Relative Value File RVU26D (October release): RVUs, PC/TC indicator and global period for CPT 78452.
Centers for Medicare & Medicaid Services, CY 2026 Physician Fee Schedule final rule, CMS-1832-F: conversion factors.
Centers for Medicare & Medicaid Services, National Correct Coding Initiative Policy Manual for Medicare Services and quarterly procedure-to-procedure edit tables.
Medicare Coverage Database billing and coding articles A56743, A56494.

CPT® is a registered trademark of the American Medical Association. Payer policy and NCCI edits change quarterly, so check your own contractor before submission. How we verify this guidance.

Related codes

• CPT 93015. Cardiovascular stress test, global.
• CPT 93350. Stress echo, imaging only.
• CPT 93351. Stress echo including ECG monitoring and supervision.

Related reading

• Cardiology billing & RCM. How we scrub cardiology claims across diagnostics, cath lab, EP and remote monitoring.
• Echocardiography billing: complete vs. limited studies. What separates a defensible complete echo from a limited one.
• TC/26 modifier errors in cardiology. The split-billing mistakes that cost diagnostic practices the most.