Summary & Overview
CPT 78429: PET Myocardial Imaging with CT Transmission
CPT code 78429 denotes a PET myocardial imaging study with a CT transmission scan used to evaluate myocardial metabolism and function. This single-study nuclear cardiology procedure provides metabolic information—such as oxygen or glucose utilization—and may include measurements of ejection fraction and ventricular wall motion. The code is nationally relevant due to the growing role of PET in assessing ischemia, viability, and advanced cardiac metabolic assessment, and because PET myocardial studies have implications for cardiac care pathways and imaging utilization.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for PET myocardial imaging, typical sites of service, and service line implications. The publication summarizes common billing and documentation themes for CPT code 78429, highlights payer coverage considerations at a national level, and outlines areas where policy updates or clinical guidance may affect utilization. The content is intended to inform coding, billing oversight, and administrative planning for facilities and payers involved in advanced cardiac imaging.
Billing Code Overview
CPT code 78429 represents a positron emission tomography (PET) myocardial imaging study with CT transmission scan performed to evaluate myocardial function and metabolism. The procedure assesses metabolic activity—such as oxygen, glucose, or drug metabolism—and may include assessment of ejection fraction and ventricular wall motion when these are performed as part of the single study.
Service type: Nuclear cardiology imaging (PET myocardial imaging) with CT transmission
Typical site of service: Hospital outpatient imaging department, dedicated nuclear medicine or PET/CT center, and freestanding imaging facility
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with known ischemic cardiomyopathy and persistent exertional angina is referred for a 78429 PET myocardial perfusion/metabolic imaging study to evaluate myocardial viability and perfusion-metabolism mismatch prior to consideration of coronary revascularization. The patient arrives at an outpatient nuclear cardiology center or hospital nuclear medicine suite. A technologist verifies identity, explains the exam, checks fasting status and medications (eg, recent beta-blockers, caffeine intake, or insulin adjustments for diabetic patients), and obtains IV access. Radiopharmaceuticals appropriate for perfusion and metabolic imaging are administered per protocol, and a low-dose CT transmission scan is acquired for attenuation correction. The interpreting physician (nuclear cardiologist or radiologist) reviews gated PET datasets for regional perfusion, metabolic activity, left ventricular ejection fraction, and wall motion; final report documents findings relevant to viability and revascularization planning. The exam is performed under standard monitoring with support from nursing and cardiology staff as needed. Typical site of service: outpatient imaging center, hospital outpatient department, or inpatient nuclear medicine department. Service type: advanced diagnostic nuclear cardiology imaging (single PET myocardial study with CT transmission for attenuation correction).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |