Summary & Overview
CPT 78491: PET Myocardial Perfusion Study, Rest or Stress
CPT code 78491 represents a PET myocardial perfusion study used to assess blood flow to the heart and, when performed, ventricular wall motion and ejection fraction at rest or during stress (exercise- or drug-induced). This imaging modality is clinically significant for evaluating ischemia, viability, and functional cardiac parameters and is increasingly relevant as PET imaging expands in availability and clinical use. Nationally, PET myocardial perfusion contributes to diagnostic pathways for coronary artery disease and can influence downstream care decisions.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical role of PET myocardial perfusion, coding context for a single rest or stress study, and what typical sites of service look like. The publication outlines common billing scenarios, payer coverage considerations, and benchmarking topics relevant to utilization and documentation. Where specific payer policies or fee benchmarks are not provided, the text notes that data are not available in the input. The material is designed for national stakeholders—including billing professionals, radiology and cardiology service leaders, and policy analysts—seeking concise guidance on the purpose and billing context of CPT code 78491.
Billing Code Overview
CPT code 78491 describes a positron emission tomography (PET) of the heart performed to evaluate myocardial perfusion (blood flow) and may include assessment of ventricular wall motion and ejection fraction when performed. The code applies to a single PET study performed either at rest or stress, where stress may be exercise- or drug-induced.
Service Type: Cardiac nuclear imaging / PET myocardial perfusion study
Typical Site of Service: Hospital outpatient imaging center, fixed-site nuclear medicine department, or freestanding imaging center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with known ischemic heart disease and exertional chest pain is referred for a single-rest pharmacologic stress positron emission tomography myocardial perfusion imaging study to evaluate for reversible myocardial ischemia and to assess ventricular wall motion and left ventricular ejection fraction. The patient presents to an outpatient nuclear cardiology clinic or hospital outpatient imaging center. Pre-procedure workflow includes medication reconciliation (holding beta-blockers or caffeine as indicated), intravenous access placement, review of renal function if PET tracer with renal clearance is used, and documentation of informed consent. If exercise stress is contraindicated or patient cannot exercise, a vasodilator or inotropic pharmacologic stress agent is administered per protocol. The PET tracer is injected at rest and/or at peak stress for a single study (78491), imaging acquisition is performed with ECG gating to permit ventricular wall motion and ejection fraction calculation, and images are reconstructed and interpreted by a qualified physician with generation of a final report. Post-procedure monitoring addresses hemodynamic stability and any adverse reactions to the stress agent before discharge to home or transfer to an inpatient bed if needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician interpretation/authorship separate from technical imaging services. |