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    v1.0.30
    OpenPayerBilling CodesDiagnostic Nuclear Medicine Procedures on the Cardiovascular SystemCPT cpt-78434-pet-myocardial-perfusion-rest-and-stress
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    CPT 78434: PET Myocardial Blood Flow Study, Rest and Stress

    Medicare pays $30 on average nationally for this procedure.

    CPT code 78434 describes a positron emission tomography (PET) study performed at both rest and pharmacologic stress to measure myocardial blood flow, with stress induced by injected medication; the service is a diagnostic cardiac PET perfusion study typically performed in an outpatient imaging center or hospital nuclear medicine/cardiology department and reported alongside the primary PET procedure code.

    For related coverage guidance, see recent payer policy updates: Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure, Cardiology - Ivabradine, Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA).

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    Clinical & Coding Specifications

    Clinical Context

    A 64-year-old patient with known ischemic heart disease and worsening exertional chest pain is referred for a pharmacologic stress myocardial perfusion PET study to quantify myocardial blood flow at rest and during stress. The nuclear medicine team reviews recent clinical history, medication list, and contraindications to vasodilator agents. On the day of service the patient arrives to the outpatient imaging center (or hospital nuclear medicine department), IV access is obtained, baseline vitals are recorded, and a PET radiopharmaceutical is administered at rest with image acquisition. A vasodilator agent (such as regadenoson or dipyridamole) is administered to induce stress, followed by a second PET radiotracer injection and stress image acquisition. The interpreting nuclear cardiologist performs image interpretation, calculates myocardial blood flow and flow reserve, documents findings and impression, and communicates actionable results to the referring cardiologist. Billing uses 78434 reported with the primary PET imaging/procedure code for myocardial perfusion imaging and may include facility and professional component reporting as appropriate.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    78452Myocardial perfusion imaging, tomographic (SPECT), single study at rest or stressAlternative nuclear perfusion modality; may be performed when PET is not available or as historical comparison.
    78460PET myocardial perfusion, attenuation correction and related localizationRelated PET imaging services; often reported to support accurate quantification and localization when performed with perfusion PET.
    78481Myocardial perfusion PET, quantification of myocardial blood flow, rest or stressCodes for PET myocardial blood flow quantification; used in conjunction with 78434 for single-phase quantification or complementary reporting depending on payer rules.
    93000Electrocardiogram, routine ECG with interpretation and reportPerformed before stress imaging to document baseline cardiac rhythm and ensure safe stress testing.
    93010Interpretation and report only for ECGUsed when ECG is performed by facility and only interpretation is billed separately.
    G0238Pharmacologic stress testing supervision with administration of stress agent (non-specific HCPCS)May be reported or required by some payers to document pharmacologic stress administration when separate reporting is allowed.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RC0000X
    207RH0000X
    208D00000X
    363L00000X
    246ZB0302X
    261QE0700X
    163WC1500X
    208U00000X

    Related Payer Policy Updates

    Specialty: Cardiology1 / 2

    10 rows

    PolicyPayerEffective Date
    Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood PressureBluecross Idaho2026-11-01
    Cardiology - IvabradineCigna2026-10-15
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Percutaneous Ventricular Assist DeviceUnitedHealthcare2026-10-01
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Left Atrial Appendage Closure Devicesexcellus_health_plan_inc2026-09-17
    Left Atrial Appendage Closure Devicesuniverahealthcare2026-09-17
    Cardiac Omnibus CodesCigna2026-09-15

    Related Codes

    CPT-78414-CARDIAC-PERFUSION-BLOOD-FLOW-ASSESSMENT

    CPT 78414: Cardiac Perfusion and Ejection Fraction Assessment

    CPT-78428-LEFT-TO-RIGHT-CARDIAC-SHUNT-DETECTION

    CPT 78428: Detection of Left-to-Right Cardiac Shunt

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

    CPT 78429: PET Myocardial Imaging, Single Study

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

    CPT 78430: PET Myocardial Perfusion Imaging with CT

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

    CPT 78431: PET Myocardial Perfusion with CT Transmission, Rest and Stress

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

    CPT 78432: PET Myocardial Perfusion and Viability Imaging

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

    CPT 78433: PET Myocardial Imaging for Perfusion and Metabolism

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

    CPT 78445: Angiography/Venography Blood Flow Imaging

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

    CPT 78451: Myocardial Perfusion SPECT, Single Study

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

    CPT 78452: Myocardial Perfusion SPECT, Multiple Studies

    Showing 1–10 of 28

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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