Summary & Overview
CPT 78433: PET Myocardial Perfusion and Metabolic Imaging with CT
CPT code 78433 represents PET myocardial imaging using two radionuclide tracers with a concurrent CT transmission scan to assess both myocardial perfusion and metabolic activity, including viability and, when performed, ejection fraction and ventricular wall motion. This advanced imaging modality contributes to cardiac diagnostics by combining perfusion and metabolic information in a single study, supporting assessment of ischemia, viability, and planning for coronary or myocardial interventions. Nationally, PET myocardial imaging is increasingly relevant as PET/CT platforms and tracer availability expand across outpatient imaging centers and hospitals.
Key payers examined in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage and billing considerations, common modifiers used with nuclear cardiology imaging, the typical clinical context for ordering this study, and benchmarking and coding guidance where available. The publication also outlines service line implications for hospital outpatient departments and specialized imaging centers and highlights clinical scenarios in which combined perfusion and metabolic PET/CT informs patient management. Data not available in the input are noted in the relevant sections.
Billing Code Overview
CPT code 78433 describes a diagnostic nuclear medicine procedure: a positron emission tomography (PET) myocardial imaging study performed with two radionuclide tracers and a concurrent CT transmission scan. The combined tracers provide information on myocardial perfusion (blood flow to and from the heart) and myocardial metabolism or viability (for example, oxygen, glucose, or drug metabolism). Ejection fraction and ventricular wall motion assessment are included when performed.
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Service type: Diagnostic PET myocardial perfusion and metabolic imaging with concurrent CT transmission scan
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Typical site of service: Hospital outpatient department or specialized imaging center equipped for PET/CT cardiac imaging
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of ischemic heart disease, prior coronary artery bypass grafting, and worsening exertional dyspnea is referred for a PET myocardial perfusion and viability study. The referring cardiologist requests assessment of myocardial perfusion, metabolic activity, and viability to determine the presence and extent of reversible ischemia and hibernating myocardium prior to consideration of revascularization. The patient arrives at an outpatient nuclear cardiology facility or hospital imaging department after appropriate dietary preparation for metabolic imaging. A nuclear medicine technologist places intravenous access and administers two radionuclide tracers per protocol (one tracer for perfusion, one for metabolic/viability imaging), and a concurrent CT transmission scan is performed for attenuation correction and anatomical localization. The interpreting nuclear cardiologist or radiologist reviews gated PET images for perfusion defects, metabolic mismatch patterns, ejection fraction, and left ventricular wall motion. Images and a structured report are finalized and transmitted to the referring cardiologist for treatment planning. Typical sites of service include hospital outpatient imaging centers, freestanding nuclear cardiology centers, and accredited cardiac PET facilities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation portion of the study separate from technical services. |