Summary & Overview
CPT 78472: Gated Cardiac Blood Pool Imaging with Wall Motion and Ejection Fraction
CPT code 78472 denotes gated equilibrium cardiac blood pool imaging with a wall motion study and ejection fraction measurement, performed at rest or with exercise or pharmacologic stress. This nuclear cardiology procedure quantifies ventricular function and assesses regional wall motion, making it important for heart failure evaluation, preoperative assessment, and monitoring response to therapy. Nationally, the code captures a commonly used noninvasive method to evaluate cardiac pump function with implications for clinical decision-making and utilization management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the service type embodied by the code. The publication also summarizes payer coverage patterns, common billing modifiers, and related service-line implications where available. Where specific input data are missing, the publication notes that such information was not provided.
This summary provides clinicians, coding professionals, and policy analysts with an at-a-glance understanding of the procedure represented by CPT code 78472, its role in evaluating cardiac function, and the areas of billing and policy attention relevant to national stakeholders.
Billing Code Overview
CPT code 78472 describes a gated equilibrium cardiac blood pool imaging study that includes a wall motion study and ejection fraction measurement to evaluate how effectively the heart pumps blood. The procedure can be performed with the patient at rest or during exercise or pharmacologic stress, providing functional assessment of ventricular performance.
Service Type: Nuclear cardiac imaging / cardiac blood pool (MUGA) study with gated imaging and wall motion analysis
Typical Site of Service: Hospital outpatient imaging center, outpatient radiology or nuclear medicine department, or freestanding imaging center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with chronic ischemic cardiomyopathy and prior myocardial infarction presents for assessment of left ventricular function and regional wall motion. The cardiologist orders a gated equilibrium radionuclide ventriculography performed at rest and during pharmacologic stress to quantify left ventricular ejection fraction (LVEF) and evaluate wall motion abnormalities. The patient arrives to the nuclear medicine suite after IV access is obtained and radiopharmaceutical labeling of the patient’s red blood cells is completed. A technologist performs positioning and ECG-gating setup, and the nuclear medicine physician reviews indications and supervises image acquisition. Images are obtained at rest and during low-level exercise on a treadmill when clinically indicated, or during pharmacologic stress with an agent such as dobutamine if the patient cannot exercise. The study provides quantitative LVEF and qualitative wall motion assessment to guide medical management, device candidacy, or further invasive testing. Typical documentation includes indication, consent, radiopharmaceutical and activity, gating quality, LVEF numeric result, wall motion description, and comparator if prior studies exist.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation of the imaging study. |