Billing code 78453: Heart perfusion imagingMedicare rate & RVUs
Reports one planar nuclear myocardial perfusion study at rest or stress when the cardiac images are acquired in a planar rather than tomographic format.
Medicare pays $262.87 for 78453 nationally in the office. Local office rates run $229.27–$365.16.
Medicare rate · 78453
Heart perfusion imaging
- Work RVUs
- 0.98
- Total RVUs
- 7.87
- Global days
- XXX
National rate · 2026
$262.87
Office setting, before claim adjustments.
See every locality for 78453 →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.
On this page 10 sections
What 78453 covers
This service captures planar nuclear images of myocardial perfusion for one study, performed at rest or under stress. A cardiologist, radiologist, or nuclear medicine physician may interpret the images; the technical work is typically performed in a hospital imaging department or an equipped outpatient practice. The study helps evaluate blood flow to the heart muscle, including in patients assessed for suspected or known coronary artery disease.
Report 78453 when the examination includes one planar perfusion study; use a multiple-study or tomographic code when the documented protocol calls for those respective formats. The record should support the indication, the rest or stress protocol, the planar acquisition, and the physician’s interpretation. Modifier 26 identifies the professional interpretation, modifier TC identifies the technical service, and an unmodified claim represents the global service. When multiple cardiovascular diagnostic procedures are billed, CMS applies the multiple-procedure reduction 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 78453 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
$229.27 to $365.16
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $233.07 | Unavailable |
| Alaska* | $292.47 | Unavailable |
| Arizona | $255.35 | Unavailable |
| Arkansas | $229.27 | Unavailable |
| Atlanta | $267.26 | Unavailable |
| Austin | $275.70 | Unavailable |
| Bakersfield | $283.95 | Unavailable |
| Baltimore/Surr. Cntys | $280.74 | Unavailable |
| Beaumont | $242.22 | Unavailable |
| Brazoria | $260.35 | Unavailable |
| Chicago | $268.55 | Unavailable |
| Chico | $283.64 | Unavailable |
| Colorado | $277.04 | Unavailable |
| Connecticut | $281.68 | Unavailable |
| Dallas | $261.78 | Unavailable |
| Dc + Md/Va Suburbs | $305.38 | Unavailable |
| Delaware | $259.97 | Unavailable |
| Detroit | $257.22 | Unavailable |
| East St. Louis | $248.11 | Unavailable |
| El Centro | $283.66 | Unavailable |
| Fort Lauderdale | $268.51 | Unavailable |
| Fort Worth | $259.55 | Unavailable |
| Fresno | $283.64 | Unavailable |
| Galveston | $260.96 | Unavailable |
| Hanford-Corcoran | $283.64 | Unavailable |
| Hawaii, Guam | $292.53 | Unavailable |
| Houston | $262.80 | Unavailable |
| Idaho | $242.96 | Unavailable |
| Indiana | $244.59 | Unavailable |
| Iowa | $241.57 | Unavailable |
| Kansas | $239.44 | Unavailable |
| Kentucky | $237.41 | Unavailable |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $304.59 | Unavailable |
| Madera | $283.64 | Unavailable |
| Manhattan | $303.66 | Unavailable |
| Merced | $283.64 | Unavailable |
| Metropolitan Boston | $307.84 | Unavailable |
| Metropolitan Kansas City | $248.95 | Unavailable |
| Metropolitan Philadelphia | $273.40 | Unavailable |
| Metropolitan St. Louis | $251.99 | Unavailable |
| Miami | $277.27 | Unavailable |
| Minnesota | $267.09 | Unavailable |
| Mississippi | $230.47 | Unavailable |
| Modesto | $283.64 | Unavailable |
| Montana** | $262.86 | Unavailable |
| Napa | $335.40 | Unavailable |
| Nebraska | $243.32 | Unavailable |
| Nevada** | $262.53 | Unavailable |
| New Hampshire | $271.75 | Unavailable |
| New Mexico | $244.71 | Unavailable |
| New Orleans | $249.94 | Unavailable |
| North Carolina | $246.46 | Unavailable |
| North Dakota** | $260.88 | Unavailable |
| Northern Nj | $301.44 | Unavailable |
| Nyc Suburbs/Long Island | $310.69 | Unavailable |
| Ohio | $243.16 | Unavailable |
| Oklahoma | $237.85 | Unavailable |
| Oxnard-Thousand Oaks-Ventura | $303.80 | Unavailable |
| Portland | $287.71 | Unavailable |
| Poughkpsie/N Nyc Suburbs | $286.58 | Unavailable |
| Puerto Rico | $265.31 | Unavailable |
| Queens | $307.71 | Unavailable |
| Redding | $283.64 | Unavailable |
| Rest Of California | $283.64 | Unavailable |
| Rest Of Florida | $254.57 | Unavailable |
| Rest Of Georgia | $239.01 | Unavailable |
| Rest Of Illinois | $245.01 | Unavailable |
| Rest Of Louisiana | $236.64 | Unavailable |
| Rest Of Maine | $243.46 | Unavailable |
| Rest Of Maryland | $265.64 | Unavailable |
| Rest Of Massachusetts | $274.73 | Unavailable |
| Rest Of Michigan | $243.57 | Unavailable |
| Rest Of Missouri | $231.48 | Unavailable |
| Rest Of New Jersey | $285.36 | Unavailable |
| Rest Of New York | $250.53 | Unavailable |
| Rest Of Oregon | $260.97 | Unavailable |
| Rest Of Pennsylvania | $244.08 | Unavailable |
| Rest Of Texas | $250.97 | Unavailable |
| Rest Of Washington | $274.51 | Unavailable |
| Rhode Island | $270.61 | Unavailable |
| Riverside-San Bernardino-Ontario | $284.74 | Unavailable |
| Sacramento-Roseville-Folsom | $299.46 | Unavailable |
| Salinas | $298.39 | Unavailable |
| San Diego-Chula Vista-Carlsbad | $306.77 | Unavailable |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $357.15 | Unavailable |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $357.04 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $365.16 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $364.69 | Unavailable |
| San Luis Obispo-Paso Robles | $293.40 | Unavailable |
| Santa Cruz-Watsonville | $310.76 | Unavailable |
| Santa Maria-Santa Barbara | $299.88 | Unavailable |
| Santa Rosa-Petaluma | $314.01 | Unavailable |
| Seattle (King Cnty) | $315.37 | Unavailable |
| South Carolina | $245.13 | Unavailable |
| South Dakota** | $260.65 | Unavailable |
| Southern Maine | $259.59 | Unavailable |
| Stockton | $283.64 | Unavailable |
| Suburban Chicago | $271.80 | Unavailable |
| Tennessee | $240.68 | Unavailable |
| Utah | $248.92 | Unavailable |
| Vallejo | $335.24 | Unavailable |
| Vermont | $258.95 | Unavailable |
| Virgin Islands | $265.31 | Unavailable |
| Virginia | $258.03 | Unavailable |
| Visalia | $283.64 | Unavailable |
| West Virginia | $234.59 | Unavailable |
| Wisconsin | $251.03 | Unavailable |
| Wyoming** | $262.00 | Unavailable |
| Yuba City | $283.64 | Unavailable |
78453 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.
$229.27
$324.40
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 | $292.47 | 1 |
| AL | $233.07 | 1 |
| AR | $229.27 | 1 |
| AZ | $255.35 | 1 |
| CA | $283.64–$365.16 | 29 |
| CO | $277.04 | 1 |
| CT | $281.68 | 1 |
| DC | $305.38 | 1 |
| DE | $259.97 | 1 |
| FL | $254.57–$277.27 | 3 |
| GA | $239.01–$267.26 | 2 |
| GU | $292.53 | 1 |
| HI | $292.53 | 1 |
| IA | $241.57 | 1 |
| ID | $242.96 | 1 |
| IL | $245.01–$271.80 | 4 |
| IN | $244.59 | 1 |
| KS | $239.44 | 1 |
| KY | $237.41 | 1 |
| LA | $236.64–$249.94 | 2 |
| MA | $274.73–$307.84 | 2 |
| MD | $265.64–$305.38 | 3 |
| ME | $243.46–$259.59 | 2 |
| MI | $243.57–$257.22 | 2 |
| MN | $267.09 | 1 |
| MO | $231.48–$251.99 | 3 |
| MS | $230.47 | 1 |
| MT | $262.86 | 1 |
| NC | $246.46 | 1 |
| ND | $260.88 | 1 |
| NE | $243.32 | 1 |
| NH | $271.75 | 1 |
| NJ | $285.36–$301.44 | 2 |
| NM | $244.71 | 1 |
| NV | $262.53 | 1 |
| NY | $250.53–$310.69 | 5 |
| OH | $243.16 | 1 |
| OK | $237.85 | 1 |
| OR | $260.97–$287.71 | 2 |
| PA | $244.08–$273.40 | 2 |
| PR | $265.31 | 1 |
| RI | $270.61 | 1 |
| SC | $245.13 | 1 |
| SD | $260.65 | 1 |
| TN | $240.68 | 1 |
| TX | $242.22–$275.70 | 8 |
| UT | $248.92 | 1 |
| VA | $258.03–$305.38 | 2 |
| VI | $265.31 | 1 |
| VT | $258.95 | 1 |
| WA | $274.51–$315.37 | 2 |
| WI | $251.03 | 1 |
| WV | $234.59 | 1 |
| WY | $262.00 | 1 |
How the 78453 rate is calculated
Each of 78453’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 · 78453
RVUs × geographic indexes × conversion factor
Work0.98
0.98 RVUs× 1.000 GPCI
Practice expense6.79
6.79 RVUs× 1.000 GPCI
Malpractice0.10
0.10 RVUs× 1.000 GPCI
Adjusted RVUs
7.8700
Conversion factor
$33.4009
Medicare rate
$262.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 78453
The CMS indicators that decide how 78453 is paid alongside other services.
CMS payment indicators · 78453
Heart perfusion imaging
| 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
78453 without 26 · national office
$262.87
Heart perfusion imaging
78453-26 · Professional component
$45.43
Pays only the interpretation and report.
78453 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 78454Heart imaging
- Choose 78453 for one planar study; 78454 represents a multiple-study planar protocol.
- 78451Cardiac SPECT
- Both describe a single myocardial perfusion study, but 78451 uses SPECT tomographic imaging rather than planar imaging.
- 78452Nuclear stress test
- 78452 is for multiple SPECT studies; 78453 is for one planar study.
- 78429Myocrd img pet 1 std w/ct
- 78429 reports PET myocardial perfusion imaging with CT, not the planar acquisition reported by 78453.
78453 billing questions
When should 78453 be selected instead of 78454?
Use 78453 for a single planar myocardial perfusion study. Use 78454 when the documented planar protocol includes multiple studies.
How does 78453 differ from 78451?
Both report a single myocardial perfusion study, but 78453 is planar imaging and 78451 is tomographic SPECT imaging.
Can the professional and technical services be billed separately?
Yes. Modifier 26 reports the professional interpretation, and modifier TC reports the technical service; billing without either modifier represents the global service.
Which part is affected by the cardiovascular multiple-procedure reduction?
CMS applies the reduction to the technical component when multiple cardiovascular diagnostic procedures are billed.
What documentation supports reporting a single study?
Document the clinical indication, whether imaging was performed at rest or stress, the planar acquisition, and the interpreting physician’s findings.
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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