Home › CPT Codes › Imaging heart muscle with nuclear medicine while at rest and under stress, producing one 2D image

CPT 78454: Imaging heart muscle with nuclear medicine while at rest and under stress, producing one 2D image - Prior Authorization and Price

CPT code 78454 is Imaging heart muscle with nuclear medicine while at rest and under stress, producing one 2D image. See what Aetna, Anthem BCBS, Cigna, UnitedHealthcare look for before approving it, the conditions their guidelines cover, and what it typically costs.

CPT 78454

Imaging heart muscle with nuclear medicine while at rest and under stress, producing one 2D image.

Nuclear Medicine
Build a submission checklist for this study

Payer guidelines that apply

PayerReviewed usingGuidelineSections
Aetna eviCore
Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026
 3 that name this code
Anthem BCBS Carelon
Imaging of the heart effective Nov 15, 2025
 4 that name this code
Cigna eviCore
Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026
Pediatric Cardiac Imaging Guidelines 1.0.2026, effective Feb 3, 2026
 3 that name this code
Medicare CMS — None found
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare UnitedHealthcare / eviCore 3 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss Imaging heart muscle with nuclear medicine while at rest and under stress, producing one 2D image. Each has its own criteria for when the study is considered appropriate.

  • Established flow-limiting CAD in asymptomatic patients Anthem BCBS
  • Established or suspected CAD Anthem BCBS
  • Indications are organized as follows Anthem BCBS
  • Suspected CAD in symptomatic patients who have not had evaluation for CAD within the preceding 60 days Anthem BCBS

Typical price

Commercial insurance, median
$1,728
Middle half of rates: $1,144 to $2,355
Medicare, hospital outpatient
$1,323
Facility payment
Medicare, physician fee schedule
$384
National, non-facility

Commercial figures come from negotiated rates published by 595 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for Imaging heart muscle with nuclear medicine while at rest and under stress, producing one 2D image change.

Frequently asked questions

Imaging CPT Code Coverage Lookup

Compare prior authorization requirements across payers

Quick Access - Common Imaging CPT Codes

CT
MRI
MRA
PET