Group 1 Codes:
78451 Ht muscle image spect sing
78452 Ht muscle image spect mult
78453 Ht muscle image planar sing
78454 Ht musc image planar mult
78466 Heart infarct image
78468 Heart infarct image (ef)
78469 Heart infarct image (3D)
Coverage Indications, Limitations, and/or Medical Necessity
The usual indications for performing myocardial perfusion imaging (MPI) procedures are:
New onset of symptoms in patients having probability of coronary artery disease (CAD);
A significant change in symptoms in an individual with known coronary artery disease;
Suspicion of chest pain of cardiac origin;
Probability of coronary artery disease (multiple risk factors and strongly suggestive symptoms) with an abnormal exercise ECG;
Abnormal cardiovascular diagnostic studies in asymptomatic patients with significant cardiac risk factors, e.g. diabetes mellitus;
Risk of a subsequent cardiac event following acute myocardial infarction;
Preoperative evaluation prior to increased risk noncardiac surgical procedures in the moderate cardiac risk patient with recent cardiac history, symptoms, or findings. Cardiac catheterization should be considered in the high risk cardiac patient’;
Postoperative assessment following myocardial revascularization procedures (e.g.,CABG, PTCA) in symptomatic patients;
Assessing postoperative asymptomatic patients after PTCA or CABG, such as in patients with an abnormal ECG response to exercise or those with rest ECG changes precluding identification of ischemia during exercise;
Assessing the patient with angiographic proven disease when it is necessary to identify the “culprit” lesion for revascularization with surgery or angioplasty;
Differentiating ischemic and non-ischemic cardiomyopathy;
Evaluating right ventricular function in patients with pulmonary hypertension; or
Evaluation following cardiac transplantation.
Myocardial perfusion imaging is not indicated:
In the absence of symptoms following normal coronary angiography.
When there is no probability of intervention:
risk too high;
patient refuses to consider; or
As repetitive, frequent testing in the absence of changing clinical parameters, especially in individuals with known CAD.
Screening for coronary disease is not a Medicare covered indication.
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
999x Not Applicable
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
99999 Not Applicable
Nuclear Cardiac Imaging Procedure Codes Myocardial Perfusion Imaging (MPI) CPT®
MPI, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)
78451 MPI, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection 78452
* The most commonly performed myocardial perfusion imaging are single (at rest or stress, CPT®78451) and multiple (at rest and stress, CPT®78452) tomographic SPECT studies.
o Evaluation of the individual’s left ventricular wall motion and ejection fraction are routinely performed during MPI and are included in the code’s definition.
o First pass studies, (CPT®78481 and CPT®78483), MUGA, (CPT®78472 and CPT®78473) and SPECT MUGA (CPT®78494) should not be reported in conjunction with MPI codes.
o Attenuation correction, when performed, is included in the MPI service by code definition. No additional code should be assigned for the billing of attenuation correction. Multi-day Studies: It is not appropriate to bill separately for the rest and stress segments of MPI even if performed on separate calendar dates. A single code is assigned to define the entire procedure on the date all portions of the study are completed.
* 3D rendering, (CPT®76376/CPT®76377), should not be billed in conjunction with MPI.
* Separate codes for such related services as treadmill testing (CPT®93015 – CPT®93018) and radiopharmaceuticals should be assigned in addition to MPI.
Myocardial Perfusion Imaging (CPT codes 78451, 78452, 78453, and 78454)
For CPT code 78451 (Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)), the AMA RUC recommended 1.40 work RVUs, while the AMA RUC recommended 1.75 work RVUs for CPT code 78452 (Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection). Upon review of the AMA RUC recommendations for these codes, it was unclear what methodology the AMA RUC used to calculate the recommended work RVUs for CPT code 78451.
Therefore, we disagreed with the AMA RUC-recommended work RVUs of 1.40 for CPT code 78451 and believe the work RVUs for the survey 25th percentile were more appropriate. Therefore, we assigned interim final work RVUs of 1.38 to CPT code 78451 for CY 2010.
For CPT code 78452, we disagreed with the reference code used, CPT code 70496 (Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing (work RVUs = 1.75)). We believe CPT code 78452 is comparable to CPT code 73219 (Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) (work RVUs = 1.62)), which has the same pre-, intra-, and post-service time. Therefore, we assigned interim final work RVUs of 1.62 to CPT code 78452 for CY 2010.
We accepted the CY 2010 recommendations of the AMA RUC for the direct PE inputs for CPT codes 78451, 78452, 78453, and 78454 (75 FR 61955).
Comment: Several commenters disagreed with the interim final work RVUs assigned by CMS for these two services. The commenters pointed out that the specialty and AMA RUC recommendations for both of these services already reflected a tremendous reduction from the work RVUs for the services as reported by multiple component codes in previous years and expressed disappointment that additional reductions were made by CMS. The commenters explained that in an effort to maintain relativity between CPT codes 78451 and 78452, the recommended RVUs for 78451 were derived by calculating the relationship between the median survey RVUs for CPT codes 78451 and 78452 and maintaining this relationship between the recommended RVUs for CPT codes 78451 and 78452. That is, the survey work RVU relationship between CPT code 78451: 78452 is [1.50 : 1.87], leading to the same relationship between the AMA RUC-recommended RVUs for 78451 : 78452 of [1.40 : 1.75]. The AMA RUC agreed that the computed work RVUs, 1.40 for CPT code 78451, maintain the relativity of the original survey data and provide an appropriate measure of the work for CPT code 78451.
The commenters believe that CMS does not have the special expertise necessary to choose a different reference code than the code selected by the multispecialty AMA RUC panel and disagreed with the reference code used by CMS for establishing work RVUs for CPT code 78452. The AMA RUC pointed out that the reference code has no associated computer post-processing analysis, requires the interpretation of fewer images, and has no additional cine-motion images to analyze and interpret, all of which are included in the myocardial perfusion imaging procedures.