CPT code 78454: Heart imaging, multiple planar studies2026 Medicare rate & RVUs in Missouri
Reports planar nuclear imaging of myocardial perfusion across multiple studies, commonly rest and stress acquisitions, when planar rather than tomographic imaging is performed.
Medicare pays $335.94–$366.10 for 78454 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.
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What 78454 covers
This service uses a nuclear medicine camera to produce planar images of myocardial perfusion in more than one study. A common clinical use is comparison of rest and stress images when evaluating suspected or known coronary artery disease. Nuclear medicine physicians, radiologists, and cardiology imaging teams may perform or interpret the examination in hospital or outpatient imaging settings. The defining feature is planar acquisition; SPECT myocardial imaging is coded in a different code family.
Select this code when the record supports multiple planar myocardial imaging studies, rather than a single study or tomographic imaging. Documentation should identify the imaging approach and the studies performed, with an interpretation addressing the myocardial images. The code has professional and technical components: report modifier 26 for interpretation, modifier TC for equipment and staff, or neither for the global service. CMS’s cardiovascular diagnostic multiple-procedure reduction applies to the technical component; the professional component is not subject to that reduction.
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 78454 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
$335.94 to $366.10
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $361.64 | Unavailable |
| Metropolitan St. Louis, MO | $366.10 | Unavailable |
| Rest of Missouri | $335.94 | Unavailable |
How the 78454 rate is calculated
Each of 78454’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 · 78454
RVUs × geographic indexes × conversion factor
Work1.31
1.31 RVUs× 1.000 GPCI
Practice expense9.99
9.99 RVUs× 1.000 GPCI
Malpractice0.14
0.14 RVUs× 1.000 GPCI
Adjusted RVUs
11.4400
Conversion factor
$33.4009
Medicare rate
$382.11
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 78454
The CMS indicators that decide how 78454 is paid alongside other services.
CMS payment indicators · 78454
Heart imaging, multiple planar 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
78454 without 26 · national office
$382.11
Heart imaging, multiple planar studies
78454-26 · Professional component
$61.12
Pays only the interpretation and report.
78454 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 78453Heart perfusion imagingSingle planar study
- Both use planar myocardial imaging; 78453 is for a single study, while 78454 is for multiple studies.
- 78452Nuclear stress testSPECT, multiple perfusion studies
- Both describe multiple-study myocardial imaging, but 78452 is for SPECT acquisition and 78454 is for planar acquisition.
- 78451Cardiac SPECTSingle rest or stress study
- 78451 is single-study SPECT myocardial imaging. Choose 78454 for multiple planar studies.
78454 billing questions
How does this differ from 78453?
Both describe planar myocardial imaging. Use 78454 for multiple studies and 78453 for a single study.
When is 78452 a better fit?
78452 describes multiple-study myocardial imaging performed with SPECT. Choose 78454 when the acquisition is planar rather than tomographic.
Does multiple studies mean multiple planar views?
No. The distinction is the number of imaging studies, not simply the number of views or projections in one study.
How should the professional and technical portions be billed?
Use modifier 26 for the professional interpretation and modifier TC for the technical service. Bill without either modifier when billing the global service.
What does the cardiovascular diagnostic multiple-procedure reduction affect?
CMS applies the reduction to the technical component. It does not apply to the professional component.
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
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