CPT code 78452: Nuclear stress test, SPECT, multiple perfusion studies2026 Medicare rate & RVUs in Missouri
Myocardial perfusion SPECT with multiple distinct studies, typically rest and stress imaging, is reported for the complete multiple-study examination.
Medicare pays $376.59–$410.08 for 78452 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
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
On this page 9 sections
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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$376.59 to $410.08
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $405.15 | Unavailable |
| Metropolitan St. Louis, MO | $410.08 | Unavailable |
| Rest of Missouri | $376.59 | Unavailable |
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.
How the rate is built · 78452
RVUs × geographic indexes × conversion factor
Work1.58
1.58 RVUs× 1.000 GPCI
Practice expense11.10
11.10 RVUs× 1.000 GPCI
Malpractice0.13
0.13 RVUs× 1.000 GPCI
Adjusted RVUs
12.8100
Conversion factor
$33.4009
Medicare rate
$427.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 78452
The CMS indicators that decide how 78452 is paid alongside other services.
CMS payment indicators · 78452
Nuclear stress test, SPECT, multiple perfusion studies
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 6 | Diagnostic cardiovascular reduction applies to the technical component. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
78452 without 26 · national office
$427.87
Nuclear stress test, SPECT, multiple perfusion studies
78452-26 · Professional component
$74.48
Pays only the interpretation and report.
78452 compared with similar codes
Compare codes · National
5 codes, side by side
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.
78452 billing questions
When should 78451 be used instead of 78452?
Use 78451 for one SPECT perfusion study, such as a stress-only protocol in which rest imaging is omitted. Use 78452 when multiple distinct perfusion studies are performed, such as rest and stress.
Is the treadmill or pharmacologic stress test included?
The separately performed and documented cardiovascular stress test may be reported with 93015, or with the appropriate components 93016, 93017, and 93018 when the work is split. Separate billing for the radiotracer or pharmacologic stress agent depends on the setting.
Can gated wall motion or ejection fraction be billed separately?
Wall motion, ejection fraction, attenuation correction, and additional quantification are included in 78452 when performed. Do not add a gated blood pool code solely to report function data obtained from the perfusion study.
How is a two-day protocol reported?
Report one unit of 78452 for the complete multiple-study examination when its phases occur on two days. Document the phases performed on each day.
Which modifiers apply in a hospital setting?
A physician billing only the interpretation uses 78452-26; the hospital bills its facility services separately. A practice furnishing both the technical service and interpretation bills the global code without a component modifier.
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
Fee sheets
Put 78452 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet