Summary & Overview
CPT 78431: PET Myocardial Perfusion Imaging, Rest and Stress
CPT code 78431 represents a PET myocardial perfusion imaging study with CT transmission, used to assess blood flow to and from the heart. The code covers multi-phase testing performed at rest and with pharmacologic or exercise stress, and may include ejection fraction and ventricular wall motion assessments when performed. This imaging modality is increasingly relevant as PET offers higher spatial and temporal resolution compared with some traditional nuclear scans, supporting more precise assessment of ischemia and viability in patients with suspected or known coronary artery disease.
Key payers covered in this national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how CPT code 78431 is billed across these payers, highlights typical sites of service such as hospital outpatient imaging departments and independent diagnostic imaging centers, and outlines clinical contexts in which the code is used.
Readers will learn operational benchmarks and coverage considerations, clinical context for appropriate utilization of PET myocardial perfusion with CT transmission, and relevant coding nuances for multi-phase rest and stress studies. Data not available in the input is noted where specific contract terms, frequency limits, or payer-specific coverage criteria are required for local decision-making.
Billing Code Overview
CPT code 78431 describes a positron emission tomography (PET) myocardial perfusion imaging study performed with a CT transmission scan. The test evaluates myocardial blood flow to and from the heart (perfusion) and may include measurements of ejection fraction and ventricular wall motion when those studies are performed. This code applies to multiple studies conducted at rest and with pharmacologic or exercise stress testing.
Service type: Nuclear cardiology imaging (PET myocardial perfusion study)
Typical site of service: Hospital outpatient imaging departments or independent diagnostic imaging centers
Clinical & Coding Specifications
Clinical Context
A 64-year-old male with a history of ischemic heart disease and prior percutaneous coronary intervention presents with exertional chest pain and dyspnea. Noninvasive evaluation with a PET myocardial perfusion imaging study is ordered to assess myocardial blood flow at rest and during pharmacologic stress (adenosine/regadenoson) due to the patients inability to exercise adequately. The procedure is performed in an outpatient nuclear cardiology or hospital imaging department. Intravenous access is obtained, radiotracer for PET perfusion is administered at rest and again with pharmacologic stress, and a low-dose CT transmission scan is acquired for attenuation correction and anatomic localization. Image acquisition includes gated perfusion images to assess left ventricular ejection fraction and ventricular wall motion when clinically indicated. The interpreting physician (cardiologist or nuclear medicine physician) reviews the reconstructed images, generates a formal report documenting perfusion defects, ejection fraction, and wall motion, and assigns appropriate diagnosis codes for ischemia or infarction as indicated. Billing uses 78431 for the multiple-rest-and-stress PET myocardial perfusion study with CT transmission scan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation/reporting portion separate from technical component |