CPT Code 78452

CPT Code 78452: Myocardial Perfusion Imaging

Myocardial Perfusion Imaging is a noninvasive diagnostic test examining blood flow in the myocardium muscle. Myocardial perfusion imaging helps identify areas with low blood flow as a result of injured or blocked arteries. MPI is an important tool in the armamentarium for the assessment of patients with suspected coronary artery disease.


CPT code 78452 is used for reporting multiple studies in myocardial perfusion imaging using SPECT. Key points related to CPT code 78452 are as follows:

  • Used for MPI studies at rest and stress: CPT code 78452 is used for MPI studies at both rest and stress. This may include a study at rest followed by a study at stress, or two separate rest and stress studies done on separate days.
  • Tomographic imaging used: Tomographic imaging with CPT 78452 uses SPECT imaging techniques to provide 3D tomographic views of the heart in order to analyze perfusion in different
  • Imaging procedure and interpretation: 78452 includes imaging procedure and interpretation by the physician.
  • Requires use of radiopharmaceutical: A radiotracer such as Tc-99m or Thallium-201
  • May include redistribution/reinjection: CPT 78452 also can include additional redistribution

How CPT Code 78452 Differs From Other Codes

CPT code 78452 differs from the other similar codes for myocardial perfusion imaging in:

  • 78451: Single MPI study at rest
  • 78453: Rest MPI study followed by stress study and redistribution/reinjection imaging
  • 78454: MPI study at rest and/or stress,
  • Hence, 78452 is used for two or more MPI studies done the same or separate days in the absence of ejection fraction data.

When To Use CPT Code 78452

The CPT code 78452 can be utilized in the clinical conditions as below:

  • Preliminary assessment for coronary artery disease
  • Preoperative assessment of cardiac risks before noncardiac surgery
  • Chest pain to be evaluated with regards to etiology
  • Risk stratification after acute coronary syndrome
  • Pre-revascularization viability assessment 
  • Assess therapeutic response following revascularization

It provides essential information for diagnosis, guiding management in patients with known or suspected coronary disease.

Overview of the Myocardial Perfusion Imaging


Following is the brief method of how myocardial perfusion imaging with SPECT is done when billing 78452:

  • Injection of radio-tracer at rest
  • Patient lies still under gamma camera for imaging
  • Stress images can be achieved using adenosine medication, stressing the heart on the patient.
  • Inject an additional radiotracer dose at peak stress
  • The patient remains still again for stress imaging.
  • Image Processing: 3D SPECT image reconstruction
  • Doctor makes interpretation and report

Documentation Necessary for 784

Key documentation components necessary to report CPT code 78452:

  • Order for MPI testing: Clinical questions, symptoms
  • Tracer dose, route, site – Radiopharmaceutical, dosage,
  • Rest and stress details – Medication for stress,
  • Processing description and images – Tomographic SPECT,
  • Interpretation and report – Review of images, impression, cardiac structure/function
  • This documentation must be such that the CPT code 78452 is used and billed properly.

Billing and Coding Guidelines

Some notes in terms of billing and coding for CPT 78452:

  • May not be billed with other MPI codes for the same DOS
  • Bill 78452 x 2 for separate rest/stress studies on separate dates of service
  • May require 59 Modifier if billed with other nuclear medicine codes
  • Verify payer policy for coverage and any prior authorization requirements.
  • Append modifier 26 if only professional component is performed
  •  Enter the number of studies in the “units” field of the claim form

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