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CPT 78414: Cardiac Perfusion Imaging with Pharmacologic Stress Assessment

CPT code 78414 designates a cardiac perfusion imaging procedure that measures blood flow in the central cardiovascular system and may include use of a pharmacologic stressor to assess changes in ejection fraction. This modality is clinically important for diagnosing ischemia, assessing ventricular function, and guiding management of patients with suspected or known coronary artery disease. Nationally, accurate coding for this service affects clinical tracking, quality measurement, and appropriate facility reimbursement for advanced cardiac imaging.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and typical sites of service, plus benchmarking expectations where available. The publication outlines coding context, common billing modifiers, and considerations for claims processing and coverage determinations.

The report provides reference benchmarks and policy summaries relevant to payers and providers, clarifies clinical context for CPT code 78414, and identifies gaps where input data is not provided. Intended readers include hospital billing managers, cardiovascular imaging specialists, and payer policy teams seeking a concise national-level briefing on coding and utilization implications for this cardiac perfusion procedure.

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Billing Code Overview

CPT code 78414 describes a diagnostic cardiac imaging procedure in which a provider uses an appropriate device or probe to assess blood flow in the central cardiovascular system. The procedure may include administration of a pharmacological agent to stimulate blood flow and measure changes in ejection fraction.

Service type: Cardiac perfusion imaging / myocardial blood flow assessment
Typical site of service: Hospital outpatient department, outpatient imaging center, or cardiac catheterization/imaging suite

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CPT 78414: Cardiac Perfusion Imaging with Pharmacologic Stress Assessment

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Get alerted when payer policies referencing 78414 are released or updated.

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Billing Code Overview

Service type: Cardiac perfusion imaging / myocardial blood flow assessment
Typical site of service: Hospital outpatient department, outpatient imaging center, or cardiac catheterization/imaging suite

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with a history of ischemic cardiomyopathy and worsening exertional dyspnea is referred for an assessment of left ventricular function. The cardiology team schedules a radionuclide ventriculography using an appropriate probe to quantify ejection fraction at rest and after pharmacologic stress to evaluate contractile reserve. The workflow includes pre-procedure consent, review of medications (holding interfering agents per local protocol), intravenous placement for radiotracer or pharmacologic agent administration, acquisition of baseline images to determine resting ejection fraction, administration of a vasodilator or inotrope to provoke coronary flow or contractility, repeat imaging to measure peak-change ejection fraction, and post-procedure monitoring for hemodynamic stability. Results are interpreted by a cardiologist or nuclear medicine physician and incorporated into the patient’s heart failure management plan.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when only the physician interpretation/report is billed separately from the technical imaging component.
`TC`	Technical component	Use when only the technical portion (equipment, technologist) is billed.
`52`	Reduced services	Use when the procedure is partially reduced or not fully performed for clinical reasons.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to patient condition or intolerance.
`76`	Repeat procedure by same physician	Data not available in the input.
`77`	Repeat procedure by another physician	Data not available in the input.
`62`	Two surgeons	When two physicians of the same specialty share performance responsibility (rare for this study).
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period	Use if an unexpected return for a related interventional cardiac procedure occurs (rarely applicable).
`80`	Assistant surgeon	Use when a qualified assistant surgeon contributes (infrequent for diagnostic imaging).
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practitioner assists in the procedure room per payer rules.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Not applicable to this imaging procedure but listed among common modifiers.
`QX`	CRNA service with medical direction by a physician	Not typically used for this procedure unless anesthesia services are billed.
`QY`	Medical direction of one CRNA by an anesthesiologist	Not typically used for this procedure unless anesthesia services are billed.

Taxonomy Code	Specialty	Notes
207RC0000X	Cardiology	Interpreting cardiologist or ordering cardiologist for ventricular function studies.
207L00000X	Nuclear Medicine	Physicians performing and interpreting radionuclide imaging.
207RP1001X	Interventional Cardiology	May be involved when imaging guides invasive procedures or peri-procedural assessment.
2084P0800X	Diagnostic Radiology	Radiologists who interpret nuclear cardiac imaging studies.
363A00000X	Nurse Practitioner	Advanced practice providers who may coordinate testing and patient management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.22`	Chronic systolic (congestive) heart failure	Used to evaluate ejection fraction and systolic function.
`I25.110`	Atherosclerotic heart disease of native coronary artery with unstable angina pectoris	Assess for ischemia-related decline in ejection fraction.
`I20.9`	Angina pectoris, unspecified	Used when evaluating ischemic contribution to ventricular dysfunction.
`I21.3`	ST elevation (STEMI) myocardial infarction of unspecified site	Post-MI assessment of ejection fraction and viability.
`R07.9`	Chest pain, unspecified	Symptom prompting assessment of cardiac function and ischemia.
`I42.0`	Dilated cardiomyopathy	Direct indication for quantifying ejection fraction and monitoring progression.
`I48.91`	Unspecified atrial fibrillation	Arrhythmia that can affect ventricular function assessment and image gating.
`Z95.1`	Presence of aortocoronary bypass graft	Post-CABG patients frequently undergo function and perfusion testing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78451`	Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, when performed); single study at rest and/or stress, only planar omitted	Often performed alongside ventricular function assessment to evaluate perfusion and ischemia.
`93306`	Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, complete, with spectral Doppler and color flow Doppler when performed	Alternative or complementary modality to assess ejection fraction and wall motion.
`93000`	Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report	Performed before stress imaging to document baseline rhythm and for safety during pharmacologic stress.
`93015`	Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ECG monitoring, and supervision, with interpretation and report	Exercise stress testing may precede or substitute pharmacologic stress when patient is able to exercise.
`78452`	Myocardial SPECT, multiple studies including attenuation correction when performed; two studies (rest and stress), tomographic	When perfusion SPECT is performed with gated acquisition to derive ejection fraction and wall motion as part of comprehensive assessment.

CPT 78428: Left-to-Right Cardiac Shunt Detection

CPT-78429-PET-MYOCARDIAL-IMAGING-PET-CT-MYOCARDIUM-FUNCTION

CPT 78429: PET Myocardial Imaging with CT Transmission

CPT-78430-PET-MYOCARDIAL-PERFUSION-IMAGING-REST-OR-STRESS

CPT 78430: PET Myocardial Perfusion Imaging, Rest or Stress

CPT-78431-PET-MYOCARDIAL-PERFUSION-IMAGING-REST-AND-STRESS

CPT 78431: PET Myocardial Perfusion Imaging, Rest and Stress

CPT-78432-PET-MYOCARDIAL-PERFUSION-METABOLIC-VIABILITY

CPT 78432: PET Myocardial Perfusion and Metabolic Viability Study

CPT-78433-PET-MYOCARDIAL-PERFUSION-METABOLIC-IMAGING-CT

CPT 78433: PET Myocardial Perfusion and Metabolic Imaging with CT

CPT-78434-PET-MYOCARDIAL-PERFUSION-REST-AND-STRESS

CPT 78434: PET Myocardial Perfusion Study, Rest and Pharmacologic Stress

CPT-78445-ANGIOGRAPHY-VENOGRAPHY-DIAGNOSTIC-VASCULAR-IMAGING

CPT 78445: Angiography/Venography for Diagnostic Vascular Imaging

CPT-78451-SINGLE-SPECT-MYOCARDIAL-PERFUSION-STUDY

CPT 78451: Single SPECT Myocardial Perfusion Study

CPT-78452-CARDIAC-PERFUSION-SPECT-MULTIPLE-STUDIES

CPT 78452: Cardiac Perfusion SPECT, Multiple Studies

Showing 1–10 of 28

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when only the physician interpretation/report is billed separately from the technical imaging component.
`TC`	Technical component	Use when only the technical portion (equipment, technologist) is billed.
`52`	Reduced services	Use when the procedure is partially reduced or not fully performed for clinical reasons.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to patient condition or intolerance.
`76`	Repeat procedure by same physician	Data not available in the input.
`77`	Repeat procedure by another physician	Data not available in the input.
`62`	Two surgeons	When two physicians of the same specialty share performance responsibility (rare for this study).
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period	Use if an unexpected return for a related interventional cardiac procedure occurs (rarely applicable).
`80`	Assistant surgeon	Use when a qualified assistant surgeon contributes (infrequent for diagnostic imaging).
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practitioner assists in the procedure room per payer rules.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Not applicable to this imaging procedure but listed among common modifiers.
`QX`	CRNA service with medical direction by a physician	Not typically used for this procedure unless anesthesia services are billed.
`QY`	Medical direction of one CRNA by an anesthesiologist	Not typically used for this procedure unless anesthesia services are billed.

Taxonomy Code	Specialty	Notes
207RC0000X	Cardiology	Interpreting cardiologist or ordering cardiologist for ventricular function studies.
207L00000X	Nuclear Medicine	Physicians performing and interpreting radionuclide imaging.
207RP1001X	Interventional Cardiology	May be involved when imaging guides invasive procedures or peri-procedural assessment.
2084P0800X	Diagnostic Radiology	Radiologists who interpret nuclear cardiac imaging studies.
363A00000X	Nurse Practitioner	Advanced practice providers who may coordinate testing and patient management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.22`	Chronic systolic (congestive) heart failure	Used to evaluate ejection fraction and systolic function.
`I25.110`	Atherosclerotic heart disease of native coronary artery with unstable angina pectoris	Assess for ischemia-related decline in ejection fraction.
`I20.9`	Angina pectoris, unspecified	Used when evaluating ischemic contribution to ventricular dysfunction.
`I21.3`	ST elevation (STEMI) myocardial infarction of unspecified site	Post-MI assessment of ejection fraction and viability.
`R07.9`	Chest pain, unspecified	Symptom prompting assessment of cardiac function and ischemia.
`I42.0`	Dilated cardiomyopathy	Direct indication for quantifying ejection fraction and monitoring progression.
`I48.91`	Unspecified atrial fibrillation	Arrhythmia that can affect ventricular function assessment and image gating.
`Z95.1`	Presence of aortocoronary bypass graft	Post-CABG patients frequently undergo function and perfusion testing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78451`	Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, when performed); single study at rest and/or stress, only planar omitted	Often performed alongside ventricular function assessment to evaluate perfusion and ischemia.
`93306`	Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, complete, with spectral Doppler and color flow Doppler when performed	Alternative or complementary modality to assess ejection fraction and wall motion.
`93000`	Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report	Performed before stress imaging to document baseline rhythm and for safety during pharmacologic stress.
`93015`	Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ECG monitoring, and supervision, with interpretation and report	Exercise stress testing may precede or substitute pharmacologic stress when patient is able to exercise.
`78452`	Myocardial SPECT, multiple studies including attenuation correction when performed; two studies (rest and stress), tomographic	When perfusion SPECT is performed with gated acquisition to derive ejection fraction and wall motion as part of comprehensive assessment.

CPT 78428: Left-to-Right Cardiac Shunt Detection

CPT-78429-PET-MYOCARDIAL-IMAGING-PET-CT-MYOCARDIUM-FUNCTION

CPT 78429: PET Myocardial Imaging with CT Transmission

CPT-78430-PET-MYOCARDIAL-PERFUSION-IMAGING-REST-OR-STRESS

CPT 78430: PET Myocardial Perfusion Imaging, Rest or Stress

CPT-78431-PET-MYOCARDIAL-PERFUSION-IMAGING-REST-AND-STRESS

CPT 78431: PET Myocardial Perfusion Imaging, Rest and Stress

CPT-78432-PET-MYOCARDIAL-PERFUSION-METABOLIC-VIABILITY

CPT 78432: PET Myocardial Perfusion and Metabolic Viability Study

CPT-78433-PET-MYOCARDIAL-PERFUSION-METABOLIC-IMAGING-CT

CPT 78433: PET Myocardial Perfusion and Metabolic Imaging with CT

CPT-78434-PET-MYOCARDIAL-PERFUSION-REST-AND-STRESS

CPT 78434: PET Myocardial Perfusion Study, Rest and Pharmacologic Stress

CPT-78445-ANGIOGRAPHY-VENOGRAPHY-DIAGNOSTIC-VASCULAR-IMAGING

CPT 78445: Angiography/Venography for Diagnostic Vascular Imaging

CPT-78451-SINGLE-SPECT-MYOCARDIAL-PERFUSION-STUDY

CPT 78451: Single SPECT Myocardial Perfusion Study

CPT-78452-CARDIAC-PERFUSION-SPECT-MULTIPLE-STUDIES

CPT 78452: Cardiac Perfusion SPECT, Multiple Studies

Showing 1–10 of 28

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 78414: Cardiac Perfusion Imaging with Pharmacologic Stress Assessment

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Billing Code Overview

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CPT 78414: Cardiac Perfusion Imaging with Pharmacologic Stress Assessment

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 78414: Cardiac Perfusion Imaging with Pharmacologic Stress Assessment

Sign up for cpt 78414 policy alerts

Billing Code Overview

CPT 78414: Cardiac Perfusion Imaging with Pharmacologic Stress Assessment

Sign up for cpt 78414 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 78414 represent and where is it typically performed?

Which billing modifiers are relevant for CPT 78414 and when should they be considered?

What other CPT codes are commonly associated with or performed alongside 78414?

Which diagnoses in the provided list commonly justify use of this procedure?

Which specialties and payers are relevant for ordering or interpreting CPT 78414?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 78414 represent and where is it typically performed?

Which billing modifiers are relevant for CPT 78414 and when should they be considered?

What other CPT codes are commonly associated with or performed alongside 78414?

Which diagnoses in the provided list commonly justify use of this procedure?

Which specialties and payers are relevant for ordering or interpreting CPT 78414?

References