CPT code 78452: Nuclear stress test, SPECT, multiple perfusion studies2026 Medicare rate & RVUs

Medicare pays $427.87 for 78452 nationally in the office. Local office rates run $373.48–$595.53.

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

What 78452 covers

Myocardial perfusion SPECT uses a radiotracer, such as technetium-99m sestamibi or tetrofosmin, and a gamma camera to assess blood flow to the heart muscle. Separate studies are commonly acquired at rest and after exercise or pharmacologic stress; redistribution or reinjection imaging may also be performed. Comparing the studies helps distinguish reversible perfusion defects from fixed defects. Attenuation correction, wall motion, ejection fraction, and additional quantification are included when performed. Nuclear cardiology teams perform the scan in offices, imaging centers, and hospital departments; a cardiologist or nuclear medicine physician interprets it.

Report one unit for the complete multiple-study SPECT examination, even when its phases occur on different days. Document the distinct study phases, tracer, stress method, and imaging findings. A separately performed and documented cardiovascular stress test may be reported with 93015 or the appropriate 93016–93018 components; tracer and stress-agent billing depends on the setting. Use modifier 26 for interpretation only, TC for the equipment and staff portion, or no component modifier for the global service. CMS applies the cardiovascular diagnostic multiple procedure reduction to the technical component when applicable.

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 78452 pays more and less

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

109 of 109 payment localities

78452 rates by state

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

How the 78452 rate is calculated

Each of 78452’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.

Payment rules and modifiers for 78452

The CMS indicators that decide how 78452 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

78452 compared with similar codes

How to choose

78451Cardiac SPECTSingle rest or stress study

Choose 78451 for one SPECT perfusion study. Choose 78452 for multiple distinct studies, such as rest and stress or studies involving redistribution or reinjection.

78454Heart imagingMultiple planar studies

Choose 78454 when multiple perfusion studies use planar imaging without tomographic reconstruction. Choose 78452 when SPECT tomographic imaging is used.

78492PET perfusionMultiple studies

Choose 78492 for multiple-study PET perfusion imaging. Choose 78452 when the multiple perfusion studies use SPECT.

78473Gated heart imagingMultiple studies

Choose 78473 for multiple-study gated cardiac blood pool imaging. Choose 78452 for multiple-study SPECT perfusion imaging; function data obtained as part of that perfusion study is included.

Codes related to 78452

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

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

Open CMS sourceHow we calculate rates