CPT 78492 Myocardial Perfusion PET Reimbursement

CPT code 78492 covers myocardial perfusion PET imaging performed at rest and during exercise- or drug-induced stress, often including gated assessment of ventricular wall motion and ejection fraction. This diagnostic cardiac imaging code is important nationally because PET perfusion studies offer high-resolution assessment of myocardial blood flow and ventricular function, influencing clinical decisions for ischemic heart disease and revascularization planning. The code is used across hospital outpatient departments, ambulatory imaging centers, and specialized cardiac PET facilities.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for myocardial perfusion PET, typical sites of service, and the administrative framing of the service for billing purposes. The publication also summarizes payer coverage patterns, common modifiers encountered in claims, and related administrative considerations.

This content provides clinicians, billing professionals, and policy analysts with a concise reference to understand what CPT code 78492 represents, why it is used, and the operational settings where the service is commonly performed. Data not available in the input is noted where applicable rather than inferred.

Billing Code Overview

CPT code 78492 describes a myocardial perfusion positron emission tomography (PET) imaging study performed with both rest and exercise- or drug-induced stress components. The procedure evaluates blood flow (perfusion) to the heart muscle and may include assessment of ventricular wall motion and ejection fraction when those measurements are performed as part of the study.

Service type: Diagnostic cardiac imaging (myocardial perfusion PET) with gated ventricular function assessment when performed

Typical site of service: Hospital outpatient imaging departments, ambulatory imaging centers, and specialized cardiac PET facilities

Data not available in the input.

Clinical Context

A 64-year-old male with known coronary artery disease and exertional chest pain is referred for a rest and stress myocardial perfusion PET study to evaluate myocardial ischemia and ventricular function. The patient arrives at an outpatient nuclear cardiology lab. After screening for contraindications to pharmacologic stress, IV access is obtained and a radiotracer appropriate for PET perfusion imaging (such as Rubidium-82 or N-13 ammonia) is administered at rest with gated image acquisition to assess perfusion and ventricular wall motion/ejection fraction. Following an appropriate interval, the patient undergoes exercise stress (treadmill) when capacity permits, or pharmacologic vasodilator stress (e.g., regadenoson or adenosine) if unable to exercise. A second radiotracer dose is administered at peak stress with gated imaging to compare rest and stress perfusion. Images are processed and interpreted by a nuclear cardiology physician, documenting perfusion defects, reversible ischemia, fixed scar, and measured ejection fraction. Results are communicated to the referring cardiologist for management planning.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation separate from technical imaging.
`TC`

Taxonomy Code	Specialty	Notes
`3344C0000X`	Nuclear Cardiology	Physicians who interpret myocardial perfusion PET studies.
`2084P0800X`	Cardiology	Referring cardiologists managing ischemic heart disease.
`207L00000X`	Radiology - Cardiac Imaging	Providers involved in advanced cardiac imaging interpretation.
`174400000X`	Diagnostic Radiology Technologist	Technologists performing PET imaging acquisition.
`367A00000X`	Nuclear Medicine Technologist	Technologists specialized in radiopharmaceutical handling and PET acquisition.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I20.9`	Angina pectoris, unspecified	Common indication to evaluate for inducible ischemia with rest/stress perfusion imaging.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Assessment of myocardial perfusion and residual ischemia or scar in known CAD.
`I21.4`	Non-ST elevation (NSTEMI) myocardial infarction	Post-infarct evaluation to identify viable myocardium and ischemia.
`I50.9`	Heart failure, unspecified	Perfusion and gated imaging provide ejection fraction and wall motion assessment.
`R07.9`	Chest pain, unspecified	Diagnostic evaluation for chest pain when ischemia is part of the differential.
`Z13.6`	Encounter for screening for cardiovascular disorders	Screening or risk stratification in select high-risk patients.
`I48.91`	Unspecified atrial fibrillation	Rhythm abnormalities may prompt ischemic evaluation when symptomatic.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78459`	Myocardial perfusion PET imaging, single study, rest or stress, tomographic (e.g., PET)	Alternative single-phase PET perfusion code when only rest or only stress is performed rather than paired rest and stress.
`78491`	Myocardial perfusion PET imaging, single study, single day (Note: historically used for one portion)	Used in some workflows where single-phase coding is required; contrast with `78492` which is rest and stress paired studies.
`93000`	Electrocardiogram, routine ECG with interpretation and report	Performed before or during stress to monitor ischemic changes and arrhythmia during exercise or pharmacologic stress.
`93010`	ECG interpretation and report only	Physician-level interpretation that may be billed separately when ECG is documented and billed independently.
`92950`	Cardiopulmonary resuscitation (external cardiac massage)	Rarely related; applicable only in case of an emergency during stress testing and documented as an additional service.

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Summary & Overview

CPT 78492: Myocardial Perfusion PET, Rest and Stress