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SPECT billing that survives the review

Nuclear stress test billing: the note payers want

Nuclear stress test billing turns on the note as much as on the codes. The codes are few: 78452 for the images, a stress code, the drug and the tracer. When a payer denies, the fix is in the note, not a resubmitted claim.

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Nuclear stress test billing: a cardiologist reviewing SPECT images at the nuclear camera in his office
78452 rest and stressOffice nuclear · POS 11Paid
In your office, the images and the read are both yours
01Coding

Single vs multiple study: 78451 and 78452

78452 bills rest and stress SPECT images on 1 claim, with wall motion and EF when performed. 78451 is a single study, and billing it twice gets denied.

Your report has to show both the rest and the stress images and a signed read. We bill 78451 only when 1 set of images was acquired. In a hospital, you bill 78452-26 for your read.

78452 CPT code
Coded from the note
CMS-1500 · Claim 20482Office nuclear · POS 11
DOSPOSCPTModDx09/16/261178452A09/16/261193015A09/16/2611A9500 x2A
Claim statusPaid
Rest and stress on 1 claim
02Stress, drug and tracer

The stress, the drug and the tracer

In your office, 93015 covers supervision, tracing and your read. In a hospital, 93016 and 93018 cover your supervision and your read. The hospital bills 93017.

A drug stress bills by drug and dose. The tracer bills per study dose, so rest and stress are 2 units. We count both from the note, not the superbill.

Stress tests
Office global, hospital split
Claims 20517, 20518Stress portion · office and hospital
Office · POS 11Claim 20517

93015

Supervision, tracing and your read

Claim statusPaid
Hospital · POS 22Claim 20518

93016, 93018

Your supervision and your read

Claim statusPaid
Stress portion coded by setting
03Denials

Prior authorization and medical necessity

Many commercial and Medicare Advantage plans require prior authorization. We get it before the patient is scheduled. Traditional Medicare wants a covered diagnosis, and some MACs want a reason for nuclear over a treadmill test.

5 things commonly deny your nuclear claims:

  • Prior authNo auth number on a plan that requires one.
  • DiagnosisA code that is not on your MAC's covered list.
  • ReasonNo note on why a treadmill test alone wasn't enough.
  • Study count78451 billed twice, for rest and for stress.
  • SignatureA read billed before it was signed.

We appeal with your note, not a resubmission. Then your doctors get a 1-page template of what your MAC wants.

Denials and appeals
Worked, not parked
Claim 20533Office nuclear 78452 · POS 11
  1. DeniedNot medically necessary
  2. AppealedWith your note: patient can't exercise
  3. Paid78452, global
Appealed with the note, paid
04Codes

Nuclear stress test CPT codes we bill

Each code pays only when your signed report supports it. In a hospital you bill the 26 for your read.

Regadenoson bills per 0.1 mg, so a 0.4 mg dose is 4 units of J2785.

Every code with its rules
CodeWhat it covers
78452SPECT MPI, multiple studies (rest and stress)
78451SPECT MPI, single study
78453, 78454Planar MPI, single and multiple
93015 to 93018Stress test, global or by component
J2785, J1245, J1250, J0153Regadenoson, dipyridamole, dobutamine, adenosine
A9500, A9502Sestamibi and tetrofosmin, per study dose
05Get in touch

Send your last 90 days of nuclear claims

We show you which were denied, for what, and whether the note or the code was the reason. Free, no strings.

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Free, no strings
Your 90-day nuclear reviewLast 90 days
  • Office: images and read paidIncluded
  • Hospital: read paidIncluded
  • Denied: the note or the codeIncluded