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36.4.9.14 Myocardial Perfusion Imaging
Myocardial perfusion imaging, using radionuclides, is a noninvasive stress test that measures coronary blood flow (perfusion), especially to the left ventricle.
Myocardial perfusion imaging is a covered benefit of the Medicaid program when medically indicated. Myocardial perfusion imaging studies will be limited to one study per day. This service includes, but is not limited to, the following procedures: 4/I/T-78460, 4/I/T-78461, 4/I/T-78464, and 4/I/T-78465.
When multiple procedure codes are billed, the most inclusive code will be paid, and all other codes will be denied.
Myocardial perfusion imaging may be performed at rest and/or during stress using physical exercise or pharmacologicals. The following procedure codes may be used to bill for cardiovascular stress testing: 5-93015, T-93017, and I-93018.
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