CPT code 78454: Heart imaging, multiple planar studies2026 Medicare rate & RVUs in Montana
Reports planar nuclear imaging of myocardial perfusion across multiple studies, commonly rest and stress acquisitions, when planar rather than tomographic imaging is performed.
In Montana, Medicare pays $382.10 for 78454 in the office.
Check a contract rate as a % of Medicare · 78454 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How Montana compares for 78454
Across 109 of 109 payment localities, the office rate for 78454 runs from $332.79 in Arkansas to $532.23 in San Benito County, CA. Montana pays $382.10. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$382.10
- Los Angeles, CA · California$443.39+$61.29
- Washington, DC area · District of Columbia$444.39+$62.29
- Miami, FL · Florida$402.94+$20.84
- Chicago, IL · Illinois$390.14+$8.04
- Manhattan, NY · New York$441.70+$59.60
- Alaska · Alaska$423.57+$41.47
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $338.37 | — |
| ArkansasArkansas | $332.79 | — |
| ArizonaArizona | $371.09 | — |
| Bakersfield, CACalifornia | $413.14 | — |
| Chico, CACalifornia | $412.71 | — |
| El Centro, CACalifornia | $412.74 | — |
| Fresno, CACalifornia | $412.71 | — |
| Hanford, CACalifornia | $412.71 | — |
| Madera, CACalifornia | $412.71 | — |
| Merced, CACalifornia | $412.71 | — |
| Modesto, CACalifornia | $412.71 | — |
| Napa, CACalifornia | $488.67 | — |
| Oxnard, CACalifornia | $442.30 | — |
| Redding, CACalifornia | $412.71 | — |
| Rest of CaliforniaCalifornia | $412.71 | — |
| Riverside, CACalifornia | $414.24 | — |
| Sacramento, CACalifornia | $435.90 | — |
| Salinas, CACalifornia | $434.35 | — |
| San Diego, CACalifornia | $446.68 | — |
| Marin County, CACalifornia | $520.54 | — |
| San Francisco, CACalifornia | $520.38 | — |
| San Benito County, CACalifornia | $532.23 | — |
| Santa Clara County, CACalifornia | $531.58 | — |
| San Luis Obispo, CACalifornia | $427.06 | — |
| Santa Cruz, CACalifornia | $452.60 | — |
| Santa Maria, CACalifornia | $436.55 | — |
| Santa Rosa, CACalifornia | $457.33 | — |
| Stockton, CACalifornia | $412.71 | — |
| Vallejo, CACalifornia | $488.44 | — |
| Visalia, CACalifornia | $412.71 | — |
| Yuba City, CACalifornia | $412.71 | — |
| ColoradoColorado | $402.96 | — |
| ConnecticutConnecticut | $409.66 | — |
| DelawareDelaware | $377.85 | — |
| Fort Lauderdale, FLFlorida | $390.22 | — |
| Rest of FloridaFlorida | $369.78 | — |
| Atlanta, GAGeorgia | $388.52 | — |
| Rest of GeorgiaGeorgia | $346.97 | — |
| Hawaii, Guam, HIHawaii | $425.85 | — |
| IowaIowa | $350.92 | — |
| IdahoIdaho | $352.95 | — |
| East St. Louis, ILIllinois | $360.15 | — |
| Rest of IllinoisIllinois | $355.71 | — |
| Suburban Chicago, ILIllinois | $395.03 | — |
| IndianaIndiana | $355.34 | — |
| KansasKansas | $347.75 | — |
| KentuckyKentucky | $344.67 | — |
| New Orleans, LALouisiana | $363.06 | — |
| Rest of LouisianaLouisiana | $343.54 | — |
| Metropolitan Boston, MAMassachusetts | $448.12 | — |
| Rest of MassachusettsMassachusetts | $399.54 | — |
| Baltimore area, MDMaryland | $408.27 | — |
| Rest of MarylandMaryland | $386.16 | — |
| Rest of MaineMaine | $353.64 | — |
| Southern Maine, MEMaine | $377.38 | — |
| Detroit, MIMichigan | $373.64 | — |
| Rest of MichiganMichigan | $353.68 | — |
| MinnesotaMinnesota | $388.49 | — |
| Metropolitan Kansas City, MOMissouri | $361.64 | — |
| Metropolitan St. Louis, MOMissouri | $366.10 | — |
| Rest of MissouriMissouri | $335.94 | — |
| MississippiMississippi | $334.51 | — |
| North CarolinaNorth Carolina | $358.06 | — |
| North DakotaNorth Dakota | $379.33 | — |
| NebraskaNebraska | $353.50 | — |
| New HampshireNew Hampshire | $395.20 | — |
| Northern New JerseyNew Jersey | $438.57 | — |
| Rest of New JerseyNew Jersey | $415.01 | — |
| New MexicoNew Mexico | $355.35 | — |
| NevadaNevada | $381.66 | — |
| NYC suburbs and Long Island, NYNew York | $451.98 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $416.76 | — |
| Queens, NYNew York | $447.70 | — |
| Rest of New YorkNew York | $364.03 | — |
| OhioOhio | $353.11 | — |
| OklahomaOklahoma | $345.36 | — |
| Portland, OROregon | $418.65 | — |
| Rest of OregonOregon | $379.38 | — |
| Metropolitan Philadelphia, PAPennsylvania | $397.48 | — |
| Rest of PennsylvaniaPennsylvania | $354.49 | — |
| Puerto RicoPuerto Rico | $385.71 | — |
| Rhode IslandRhode Island | $393.44 | — |
| South CarolinaSouth Carolina | $356.05 | — |
| South DakotaSouth Dakota | $379.00 | — |
| TennesseeTennessee | $349.58 | — |
| Austin, TXTexas | $401.01 | — |
| Beaumont, TXTexas | $351.74 | — |
| Brazoria, TXTexas | $378.42 | — |
| Dallas, TXTexas | $380.50 | — |
| Fort Worth, TXTexas | $377.23 | — |
| Galveston, TXTexas | $379.32 | — |
| Houston, TXTexas | $381.88 | — |
| Rest of TexasTexas | $364.64 | — |
| UtahUtah | $361.61 | — |
| VirginiaVirginia | $375.06 | — |
| Virgin Islands, VIUnited States Virgin Islands | $385.71 | — |
| VermontVermont | $376.46 | — |
| Rest of WashingtonWashington | $399.24 | — |
| King County, WAWashington | $459.18 | — |
| WisconsinWisconsin | $364.86 | — |
| West VirginiaWest Virginia | $340.41 | — |
| WyomingWyoming | $380.89 | — |
78454 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$332.79
$472.47
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $423.57 | 1 |
| AL | $338.37 | 1 |
| AR | $332.79 | 1 |
| AZ | $371.09 | 1 |
| CA | $412.71–$532.23 | 29 |
| CO | $402.96 | 1 |
| CT | $409.66 | 1 |
| DC | $444.39 | 1 |
| DE | $377.85 | 1 |
| FL | $369.78–$402.94 | 3 |
| GA | $346.97–$388.52 | 2 |
| GU | $425.85 | 1 |
| HI | $425.85 | 1 |
| IA | $350.92 | 1 |
| ID | $352.95 | 1 |
| IL | $355.71–$395.03 | 4 |
| IN | $355.34 | 1 |
| KS | $347.75 | 1 |
| KY | $344.67 | 1 |
| LA | $343.54–$363.06 | 2 |
| MA | $399.54–$448.12 | 2 |
| MD | $386.16–$444.39 | 3 |
| ME | $353.64–$377.38 | 2 |
| MI | $353.68–$373.64 | 2 |
| MN | $388.49 | 1 |
| MO | $335.94–$366.10 | 3 |
| MS | $334.51 | 1 |
| MT | $382.10 | 1 |
| NC | $358.06 | 1 |
| ND | $379.33 | 1 |
| NE | $353.50 | 1 |
| NH | $395.20 | 1 |
| NJ | $415.01–$438.57 | 2 |
| NM | $355.35 | 1 |
| NV | $381.66 | 1 |
| NY | $364.03–$451.98 | 5 |
| OH | $353.11 | 1 |
| OK | $345.36 | 1 |
| OR | $379.38–$418.65 | 2 |
| PA | $354.49–$397.48 | 2 |
| PR | $385.71 | 1 |
| RI | $393.44 | 1 |
| SC | $356.05 | 1 |
| SD | $379.00 | 1 |
| TN | $349.58 | 1 |
| TX | $351.74–$401.01 | 8 |
| UT | $361.61 | 1 |
| VA | $375.06–$444.39 | 2 |
| VI | $385.71 | 1 |
| VT | $376.46 | 1 |
| WA | $399.24–$459.18 | 2 |
| WI | $364.86 | 1 |
| WV | $340.41 | 1 |
| WY | $380.89 | 1 |
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.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
9,374
- Code
- 78454
- Physician work
- 1.31
- Practice expense
- 9.99
- Malpractice
- 0.14
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.31 | × 1.000 | 1.3100 |
| Practice expense | 9.99 | × 1.000 | 9.9900 |
| Malpractice | 0.14 | × 0.998 | 0.1397 |
| Total RVUs | 11.4397 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$382.10
Office: (1.31 × 1 + 9.99 × 1 + 0.14 × 0.998) × $33.4009 = $382.10
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.
How 78454 has changed in Montana
78454 · Office / nonfacility
$382.10
Effective 2026-10-01
The base rate is $3.41 higher than on 2025-10-01, moving from $378.69 to $382.10 (0.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$378.69changed to$382.10
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.34 changed to 1.31
- Practice expense RVU 10.25 changed to 9.99
- Malpractice RVU 0.12 changed to 0.14
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$397.35changed to$378.69
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 10.46 changed to 10.25
- Malpractice RVU 0.14 changed to 0.12
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$390.86changed to$397.35
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$412.30changed to$390.86
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 10.69 changed to 10.46
January 1, 2023
RVU23A
$425.20changed to$412.30
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 10.81 changed to 10.69
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$444.11changed to$425.20
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 11.29 changed to 10.81
- Malpractice RVU 0.10 changed to 0.14
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$449.55changed to$444.11
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 10.96 changed to 11.29
- Malpractice RVU 0.12 changed to 0.10
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$455.38changed to$449.55
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 11.10 changed to 10.96
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$463.88changed to$455.38
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 11.35 changed to 11.10
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$459.79changed to$463.88
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 11.30 changed to 11.35
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$457.12changed to$459.79
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 11.28 changed to 11.30
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$454.93changed to$457.12
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 11.21 changed to 11.28
- Malpractice RVU 0.09 changed to 0.12
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$452.67changed to$454.93
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$446.17changed to$452.67
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 11.01 changed to 11.21
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
$450.44changed to$446.17
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 11.80 changed to 11.01
- Malpractice GPCI 1.103 changed to 1.165
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $450.44
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $382.10 | Not available in this setting | RVU26D |
| 2026-07-01 | $382.10 | Not available in this setting | RVU26C |
| 2026-04-01 | $382.10 | Not available in this setting | RVU26B |
| 2026-01-01 | $382.10 | Not available in this setting | RVU26A |
| 2025-10-01 | $378.69 | Not available in this setting | RVU25D |
| 2025-07-01 | $378.69 | Not available in this setting | RVU25C |
| 2025-04-01 | $378.69 | Not available in this setting | RVU25B |
| 2025-01-01 | $378.69 | Not available in this setting | RVU25A |
| 2024-10-01 | $397.35 | Not available in this setting | RVU24D |
| 2024-07-01 | $397.35 | Not available in this setting | RVU24C |
| 2024-04-01 | $397.35 | Not available in this setting | RVU24B |
| 2024-03-09 | $397.35 | Not available in this setting | RVU24AR |
| 2024-01-01 | $390.86 | Not available in this setting | RVU24A |
| 2023-10-01 | $412.30 | Not available in this setting | RVU23D |
| 2023-07-01 | $412.30 | Not available in this setting | RVU23C |
| 2023-04-01 | $412.30 | Not available in this setting | RVU23B |
| 2023-01-01 | $412.30 | Not available in this setting | RVU23A |
| 2022-10-01 | $425.20 | Not available in this setting | RVU22D |
| 2022-07-01 | $425.20 | Not available in this setting | RVU22C |
| 2022-04-01 | $425.20 | Not available in this setting | RVU22B |
| 2022-01-01 | $425.20 | Not available in this setting | RVU22A |
| 2021-10-01 | $444.11 | Not available in this setting | RVU21D |
| 2021-07-01 | $444.11 | Not available in this setting | RVU21C |
| 2021-04-01 | $444.11 | Not available in this setting | RVU21B |
| 2021-01-01 | $444.11 | Not available in this setting | RVU21A |
| 2020-10-01 | $449.55 | Not available in this setting | RVU20D |
| 2020-07-01 | $449.55 | Not available in this setting | RVU20C |
| 2020-04-01 | $449.55 | Not available in this setting | RVU20B |
| 2020-01-01 | $449.55 | Not available in this setting | RVU20A |
| 2019-10-01 | $455.38 | Not available in this setting | RVU19D |
| 2019-07-01 | $455.38 | Not available in this setting | RVU19C |
| 2019-04-01 | $455.38 | Not available in this setting | RVU19B |
| 2019-01-01 | $455.38 | Not available in this setting | RVU19A |
| 2018-10-01 | $463.88 | Not available in this setting | RVU18D |
| 2018-07-01 | $463.88 | Not available in this setting | RVU18C |
| 2018-04-01 | $463.88 | Not available in this setting | RVU18B |
| 2018-01-01 | $463.88 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $459.79 | Not available in this setting | RVU17D |
| 2017-07-01 | $459.79 | Not available in this setting | RVU17C |
| 2017-04-01 | $459.79 | Not available in this setting | RVU17B |
| 2017-01-01 | $459.79 | Not available in this setting | RVU17A |
| 2016-10-01 | $457.12 | Not available in this setting | RVU16D |
| 2016-07-01 | $457.12 | Not available in this setting | RVU16C |
| 2016-04-01 | $457.12 | Not available in this setting | RVU16B |
| 2016-01-01 | $457.12 | Not available in this setting | RVU16A |
| 2015-10-01 | $454.93 | Not available in this setting | RVU15D |
| 2015-07-01 | $454.93 | Not available in this setting | RVU15C |
| 2015-04-01 | $452.67 | Not available in this setting | RVU15B |
| 2015-01-01 | $452.67 | Not available in this setting | RVU15A |
| 2014-10-01 | $446.17 | Not available in this setting | RVU14D |
| 2014-07-01 | $446.17 | Not available in this setting | RVU14C |
| 2014-04-01 | $446.17 | Not available in this setting | RVU14B |
| 2014-01-01 | $446.17 | Not available in this setting | RVU14A |
| 2013-10-01 | $450.44 | Not available in this setting | RVU13D |
| 2013-07-01 | $450.44 | Not available in this setting | RVU13C |
| 2013-04-01 | $450.44 | Not available in this setting | RVU13B |
| 2013-01-01 | $450.44 | Not available in this setting | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
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
Fee sheets · Coming soon
Put 78454 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist