Stress Test CPT Codes

At first glance, billing for a stress test might seem straightforward—after all, it’s a common procedure used by cardiologists, primary care physicians, and hospitals alike. But beneath the surface, choosing the correct CPT code requires careful attention to details like test type, imaging involvement, and supervision levels.

Many providers unknowingly use the wrong code, miss key modifiers, or fail to document properly, leading to delayed payments or outright denials. This guide breaks down Stress Test CPT codes step by step, helping you ensure accurate claims, proper reimbursement, and a seamless billing process.

Commonly Used CPT Codes For Stress Tests

Exercise (Treadmill) ECG Stress Test CPT Codes (93015–93018)

A standard exercise stress test (e.g., treadmill or bicycle) with continuous EKG monitoring is reported using the 93015–93018 CPT code series. These codes cover different billing components based on who supervises, performs, and interprets the test.

• 93015 – Complete cardiovascular stress test (includes supervision, ECG monitoring, interpretation, and report). This is the global code used when a single provider or entity performs all parts of the test.

• 93016 – Supervision only (no interpretation or report). Used when one physician supervises the test but does not provide the final interpretation.

• 93017 – EKG tracing only (technical component, no interpretation). Typically used by the facility performing the test.

• 93018 – Interpretation and report only (physician reading the results). Used when a separate provider interprets the test results.

Since exercise and pharmacologic stress tests use the same CPT codes, the key distinction in billing comes from who performs which part of the service.

Pharmacologic Stress Test CPT Codes (93015–93018 + J-Codes)

When a patient cannot exercise, a pharmacologic stress test is conducted using drugs like adenosine, regadenoson (Lexiscan), dipyridamole, or dobutamine. The same CPT codes (93015–93018) apply, covering the test supervision, ECG monitoring, and interpretation. However, an additional HCPCS J-code is used to bill for the pharmacologic stressing agent:

• J0153 – Injection, adenosine (per 1 mg)

• J1245 – Injection, dipyridamole (per 10 mg)

• J1250 – Injection, dobutamine HCl (per 250 mg)

• J2785 – Injection, regadenoson 0.1 mg (Lexiscan)

These J-codes account for the cost of the stressing agent, and each must be documented separately along with the stress test CPT code.

Stress Echocardiography (Echo Stress Test) CPT Codes (93350–93352)

A stress echocardiogram combines EKG stress testing with ultrasound imaging of the heart at rest and stress. The CPT codes used depend on whether the echocardiography and stress test are billed together or separately:

• 93350 – Transthoracic echocardiography during rest and stress (exercise or pharmacologic), with interpretation and report. Used when the echo imaging is billed separately from the stress test.

• 93351 – Complete stress echocardiography (includes supervision, ECG monitoring, and imaging). Used when the same provider performs both the stress test and echo.

• 93352 – Use of contrast agent during stress echocardiography (add-on code). Applied if an echocardiographic contrast agent is used to enhance imaging.

When billing separately, 93350 is used alongside 93015/93016/93018 depending on how the stress test is performed. 93351, however, is a bundled code that includes both stress test monitoring and imaging.

Nuclear Stress Test / Myocardial Perfusion Imaging CPT Codes (78451–78452)

A nuclear stress test evaluates myocardial perfusion using a radiopharmaceutical agent and SPECT imaging. Though the CMS article did not explicitly list these codes, they are standard for nuclear stress testing:

• 78451 – Myocardial perfusion imaging, single study (either rest or stress).

• 78452 – Myocardial perfusion imaging, multiple studies (rest and stress).

For a full nuclear stress test with both rest and stress images, 78452 is typically used. These imaging codes are billed separately from the stress test itself (93015–93018).

Fetal Non-Stress Test (NST) CPT Code (59025)

A fetal non-stress test (NST) is an obstetric test that monitors fetal heart rate in response to movement. It is coded as:

• 59025 – Fetal non-stress test, antepartum monitoring

This code is unrelated to cardiovascular stress tests and was not covered in the CMS cardiovascular stress testing article. However, it is commonly used in obstetrics billing.

Final Thoughts

Selecting the correct CPT code for a stress test depends on:

✅ Test type (exercise, pharmacologic, echocardiography, nuclear imaging)
✅ Billing components (global vs. separate billing for supervision, ECG tracing, interpretation)
✅ Use of additional agents (pharmacologic stressing drugs or echocardiographic contrast)

By accurately coding stress tests, providers can ensure proper reimbursement, avoid claim denials, and streamline billing processes. Using the right CPT codes for each test variation is essential to maintaining billing accuracy and financial efficiency in cardiology and related specialties.

Let HMS USA LLC Handle Your Cardiology Billing

At HMS USA LLC, we specialize in cardiology medical billing with a deep understanding of CPT coding, modifier application, and insurance guidelines for stress tests, echocardiograms, and nuclear imaging. Our team ensures:

✔ Error-free claims submission to maximize reimbursements
✔ Expert handling of CPT coding & modifiers for stress tests
✔ Reduction in claim denials & faster payment cycles
✔ Compliance with CMS & payer-specific billing rules

If you're looking for a trusted cardiology billing partner, HMS USA LLC is here to optimize your revenue cycle and reduce administrative burdens.