Summary & Overview
CPT 0742T: Absolute Quantitation of Myocardial Blood Flow (SPECT Add-on)
CPT code 0742T designates absolute quantitation of myocardial blood flow (AQMBF) performed as an add-on to a primary SPECT myocardial perfusion imaging study, typically acquired under pharmacologic or exercise-induced stress and optionally at rest. This measurement provides quantitative blood flow metrics that can enhance diagnostic precision for ischemia and coronary flow abnormalities beyond standard qualitative perfusion images. Nationally, adoption of quantitative myocardial blood flow measures is growing as imaging centers and payers evaluate clinical utility and coding clarity for advanced nuclear cardiology techniques.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage and billing considerations seen across major commercial payers and federal programs, highlighting areas where policy language, bundling guidance, and documentation expectations matter for correct use of an add-on code.
Readers will learn the clinical context for using CPT code 0742T, typical sites of service, and the role of AQMBF in complementing SPECT perfusion studies. The report provides benchmarks and policy-relevant observations about payer coverage patterns, documentation points that support medical necessity, and how this add-on service fits within cardiac imaging service lines. Data limitations are noted where input details were not provided.
Billing Code Overview
CPT code 0742T is an add-on imaging code used when a provider performs absolute quantitation of myocardial blood flow (AQMBF) as part of a primary SPECT myocardial perfusion imaging study. The service is performed under stress conditions and may also be performed at rest when clinically indicated.
Service Type: Cardiac nuclear imaging — quantitative myocardial blood flow measurement (add-on to primary SPECT perfusion study)
Typical Site of Service: Outpatient imaging center or hospital outpatient department, where SPECT myocardial perfusion studies are performed using nuclear medicine facilities and personnel.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male with exertional chest pain, hypertension, and known coronary artery disease being evaluated for ischemia. The patient presents to an outpatient nuclear cardiology laboratory for a single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) study with pharmacologic or exercise stress. The technologist administers radiopharmaceuticals and performs gated SPECT acquisition. As an add-on to the primary SPECT MPI study, the interpreting physician performs absolute quantitation of myocardial blood flow (0742T) during the stress portion and, if indicated by protocol, at rest. The workflow includes pre-test clinical assessment, medication reconciliation, informed consent, stress administration (exercise or pharmacologic), SPECT image acquisition, image processing with software that generates quantitative myocardial blood flow values, and physician interpretation with a formal report documenting absolute flow values, flow reserve if rest images are obtained, and comparison to prior studies when available. Typical sites of service are outpatient imaging centers, hospital-based nuclear medicine or cardiology departments, and ambulatory surgery centers when coupled with other procedures. Common clinical indications include evaluation of suspected or known ischemic heart disease, assessment of microvascular dysfunction, and pre-operative cardiac risk assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Used when billing only the physician interpretation portion separate from technical imaging services. |
TC | Technical component | Used when billing only the technical component (equipment, technologist, radiopharmaceuticals) and not the physician interpretation. |
59 | Distinct procedural service | Not provided in the raw modifier list; Data not available in the input. |
52 | Reduced services | Used when the procedure is partially reduced or not completed as originally intended. |
53 | Discontinued procedure | Used when the study is started but discontinued due to patient instability or other reasons. |
26 | Professional component | Used when only the physician interpretation/report is billed separate from the facility/technical charge. |
52 | Reduced services | Used when elements of the protocol are abbreviated (for example, if rest images are omitted due to stress-only protocol). |
53 | Discontinued procedure | Used when acquisition is aborted (e.g., patient intolerance to stress) and the add-on quantitation cannot be completed. |
62 | Two surgeons | Not typically applicable to this nuclear cardiology procedure; use only when two surgeons are required for a separate invasive procedure on same date. |
80 | Assistant at surgery | Not applicable to noninvasive imaging; rarely used. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Not applicable to this imaging service. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RC0000X | Nuclear Cardiology Medicine | Physicians who interpret SPECT MPI and perform quantitative flow analysis. |
| 2080P0207X | Cardiovascular Disease | Cardiologists who order and interpret MPI and AQMBF data. |
| 2085S0101X | Nuclear Medicine | Nuclear medicine physicians who oversee radiopharmaceutical administration and image interpretation. |
| 363L00000X | Radiology – Diagnostic Radiology | Diagnostic radiologists with nuclear imaging expertise who may interpret SPECT MPI and quantitative flow studies. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I20.9 | Angina pectoris, unspecified | Common indication for SPECT MPI and assessment of myocardial blood flow to evaluate ischemia. |
I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | Used for patients with known CAD undergoing evaluation of perfusion and flow reserve. |
I48.91 | Unspecified atrial fibrillation | Patients with arrhythmia may undergo risk stratification with MPI prior to procedures; arrhythmia can affect image quality and interpretation. |
R07.9 | Chest pain, unspecified | Symptom prompting ischemia evaluation with SPECT MPI and AQMBF. |
I50.9 | Heart failure, unspecified | Used when MPI is performed as part of evaluation of ischemic contribution to heart failure symptoms. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
78452 | Myocardial perfusion imaging, tomographic (SPECT) with quantitative or qualitative planar imaging, single study (rest OR stress) | Primary SPECT MPI study to which 0742T is an add-on for absolute quantitation of myocardial blood flow; the base study provides image acquisition and interpretation. |
78451 | Myocardial perfusion imaging, tomographic (SPECT) with quantitative or qualitative planar imaging, multiple studies (e.g., rest and stress) | Used when both rest and stress SPECT acquisitions are performed; absolute quantitation (0742T) may be reported in addition to the base multi-study code. |
93000 | Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report | Performed immediately before stress testing to document baseline rhythm and for safety screening prior to stress administration. |
93015 | Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, including continuous ECG monitoring, interpretation and report | Exercise stress component that may be used with SPECT MPI and AQMBF measurement when exercise stress is feasible. |
93351 | Dobutamine stress echocardiography, including imaging, interpretation and report | Alternative stress imaging modality; included to show related non-nuclear stress testing options in the cardiac imaging workflow. |