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39.3.5 Myocardial Perfusion Imaging
Myocardial perfusion imaging, which uses 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 Texas Medicaid Program when it is medically indicated.
Myocardial perfusion imaging studies will be limited to one study per day, including, but not limited to, the following procedure codes: 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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