Summary & Overview
CPT 78468: Planar Nuclear Myocardial Imaging with Ejection Fraction
CPT code 78468 covers planar nuclear myocardial imaging performed after injection of a radiotracer that accumulates in areas of damaged myocardium, used to detect and localize injury from a recent myocardial infarction and to measure ventricular ejection fraction. The code is part of nuclear cardiology services critical for post-infarct evaluation and management planning. Nationally, this imaging modality supports clinical decision-making about revascularization, medical therapy, and prognosis after acute coronary events.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the test, typical sites of service, and the payer landscape relevant to coverage and claims processing. The publication summarizes common modifiers and billing considerations, identifies where data was unavailable, and situates CPT code 78468 within the broader set of nuclear cardiology procedures. The piece is intended to inform coding staff, practice managers, and policy analysts about the clinical context and billing implications of this cardiac imaging service at a national level.
Billing Code Overview
CPT code 78468 describes a planar nuclear imaging study of the myocardium performed after injection of a radiotracer that localizes in areas of damaged heart muscle. The procedure is used to identify and localize myocardial damage following a recent myocardial infarction and to measure ventricular ejection fraction by tracking changes in radioactivity as the tracer moves through the heart.
Service type: Myocardial perfusion nuclear imaging (planar), diagnostic imaging with ventricular function assessment
Typical site of service: Hospital outpatient imaging departments, hospital-based nuclear medicine suites, and freestanding nuclear cardiology centers
Data not available in the input for Associated Taxonomies, ICD-10 Diagnoses, and Related Codes.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male presents to the nuclear medicine department 3 days after hospital admission for an acute ST-elevation myocardial infarction (MI) managed with percutaneous coronary intervention. The cardiology team requests planar myocardial perfusion imaging with radiotracer injection to evaluate the extent and location of infarcted myocardium and to estimate left ventricular ejection fraction. The patient is hemodynamically stable, in a supine position on the imaging table, and intravenous access is obtained for administration of the radiopharmaceutical (commonly 99mTc-labeled agent). Planar images of the heart are acquired at specified time points post-injection to identify areas of decreased tracer uptake consistent with damaged myocardium. The interpreting physician reviews image quality, documents findings including infarct size and regional perfusion defects, and reports an ejection fraction derived from activity changes. Typical documentation includes indication (recent MI), procedure performed (78468), radiopharmaceutical used, imaging technique (planar cardiac imaging), quantitative EF measurement, comparison to prior studies if available, and any complications during injection or imaging.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation and report separate from technical imaging services. |