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CPT code 78451: Cardiac SPECT, single rest or stress study2026 Medicare rate & RVUs

Reports one SPECT myocardial perfusion study at rest or stress to assess blood flow to the heart muscle in suspected or known coronary disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities20.3K Medicare services in 2024

Medicare pays $311.30 for 78451 nationally in the office. Local office rates run $272.61–$430.89.

Medicare rate · 78451

Cardiac SPECT, single rest or stress study

Office or facility?

Work RVUs
1.35
Total RVUs
9.32
Global days
XXX

National rate · 2026

$311.30

Office setting, before claim adjustments.

See every locality for 78451 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 78451 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 78451 covers

This service uses a radiopharmaceutical and a gamma camera to create tomographic images of myocardial perfusion for one study, performed at rest or under exercise or pharmacologic stress. Cardiologists, nuclear medicine physicians, and radiologists may interpret the images in hospital or outpatient imaging settings. Clinicians commonly use the study to evaluate suspected or established coronary artery disease and possible ischemia or prior myocardial injury.

Report 78451 for a single rest or stress study; when both rest and stress studies are performed, 78452 is the related SPECT code. Documentation should identify the study condition and support the imaging and interpretation performed. The code has professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies equipment and staff, and no component modifier represents the global service. The cardiovascular diagnostic multiple procedure reduction applies to the technical component.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 78451 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 payment localities

$272.61 to $430.89

$272.61$351.75$430.89
One dot per payment locality, office / nonfacility. Hover a dot to see the locality; select it to open that rate.

109 of 109 payment localities

78451 office and facility rates by payment locality
Payment localityOfficeFacility
Alabama$276.99Unavailable
Alaska$349.43Unavailable
Arizona$302.67Unavailable
Arkansas$272.61Unavailable
Atlanta, GA$316.31Unavailable
Austin, TX$326.25Unavailable
Bakersfield, CA$336.08Unavailable
Baltimore area, MD$332.00Unavailable
Beaumont, TX$287.40Unavailable
Brazoria, TX$308.56Unavailable

78451 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$272.61

$383.32

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
78451 office rate range by state
State / territoryOffice rate rangeLocalities
AK$349.431
AL$276.991
AR$272.611
AZ$302.671
CA$335.75–$430.8929
CO$327.931
CT$333.141
DC$360.901
DE$308.031
FL$301.41–$327.183
GA$283.55–$316.312
GU$345.901
HI$345.901
IA$286.941
ID$288.511
IL$290.31–$321.294
IN$290.391
KS$284.401
KY$281.831
LA$280.93–$296.242
MA$325.27–$363.772
MD$314.63–$360.903
ME$289.00–$307.702
MI$288.86–$304.392
MN$316.571
MO$274.93–$298.693
MS$273.891
MT$311.291
NC$292.481
ND$309.311
NE$288.981
NH$321.661
NJ$337.61–$356.422
NM$290.151
NV$311.001
NY$297.16–$366.735
OH$288.451
OK$282.421
OR$309.25–$340.342
PA$289.56–$323.532
PR$314.141
RI$320.471
SC$290.821
SD$309.081
TN$285.831
TX$287.40–$326.258
UT$295.181
VA$305.85–$360.902
VI$314.141
VT$307.021
WA$325.02–$372.612
WI$297.941
WV$278.301
WY$310.431

How the 78451 rate is calculated

Each of 78451’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 78451

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.35

1.35 RVUs× 1.000 GPCI

Practice expense7.87

7.87 RVUs× 1.000 GPCI

Malpractice0.10

0.10 RVUs× 1.000 GPCI

Adjusted RVUs

9.3200

Conversion factor

$33.4009

Medicare rate

$311.30

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 78451

The CMS indicators that decide how 78451 is paid alongside other services.

CMS payment indicators · 78451

Cardiac SPECT, single rest or stress study

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures6Diagnostic cardiovascular reduction applies to the technical component.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical1Diagnostic test with separate professional (26) and technical (TC) components.

What modifiers do to the payment

Modifier 26 · payment effect

With and without the modifier

78451 without 26 · national office

$311.30

Cardiac SPECT, single rest or stress study

78451-26 · Professional component

$63.13

Pays only the interpretation and report.

When to use modifier 26

78451 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 78451

    Cardiac SPECT, single rest or stress study1.35 wRVU

    $311.30

  • 78452

    Nuclear stress test, SPECT, multiple perfusion studies1.58 wRVU

    $427.87+$116.57

  • 78453

    Heart perfusion imaging, single planar study0.98 wRVU

    $262.87−$48.43

  • 78454

    Heart imaging, multiple planar studies1.31 wRVU

    $382.11+$70.81

  • 78491

    Myocardial PET, single study0 wRVU

    Not priced

How to choose

78452Nuclear stress testSPECT, multiple perfusion studies
Both describe myocardial perfusion SPECT. Choose 78451 for one rest or stress study; 78452 represents multiple studies, commonly rest and stress.
78453Heart perfusion imagingSingle planar study
78453 describes a single myocardial perfusion study using planar imaging. 78451 is for tomographic SPECT imaging.
78454Heart imagingMultiple planar studies
78454 is the multiple-study planar myocardial perfusion code. 78451 is tomographic SPECT for a single study.
78491Myocardial PETSingle study
78491 is myocardial perfusion imaging with PET. Use 78451 when the modality performed is SPECT.

Codes related to 78451

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 78451
CodeHow it relatesNational office range
Same family
78452Nuclear stress test, SPECT, multiple perfusion studiesSPECT myocardial perfusion code for multiple studies, such as rest and stress.$373.48–$595.53
Used instead
78453Heart perfusion imaging, single planar studySingle-study myocardial perfusion imaging using planar rather than tomographic imaging.$229.27–$365.16
78454Heart imaging, multiple planar studiesMultiple-study myocardial perfusion imaging using planar rather than tomographic imaging.$332.79–$532.23
78491Myocardial PET, single studyMyocardial perfusion imaging by PET rather than SPECT.No office rate

78451 billing questions

When is 78451 reported instead of 78452?

Use 78451 for one SPECT myocardial perfusion study at rest or stress. When the service includes both rest and stress studies, compare the documentation with 78452.

Does one study mean one image or one view?

No. The distinction is the number of myocardial perfusion studies, not the number of image slices or views. Document whether the single study was performed at rest or stress.

How should the professional and technical work be billed?

Use modifier 26 for the physician's interpretation and modifier TC for the equipment and staff. Report the global service without either component modifier when one claim includes both portions.

Can the technical component be reduced when other tests are performed?

The cardiovascular diagnostic multiple procedure reduction applies to the technical component of 78451. It does not change the professional component.

What documentation supports 78451?

Document that myocardial perfusion SPECT was performed, whether the single study was at rest or stress, and the physician's interpretation. For stress imaging, identify the stress method used.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 78451PPRRVU2026_Oct_nonQPP.csv, line 9,365 (RVU26D)

Open CMS sourceHow we calculate rates

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