CPT 78020 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Radiology Procedures • Nuclear Medicine Procedures |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Low |
National average reimbursement for CPT 78020 by major payers:
$99.43
$97.95
$96.59
$120.18
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 78020 | ||||||
United | 78020 | $26.45 | 1851400485 - GEORGE HEMSTREET | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Interventional Cardiology Physician (207RI0011X) |
United | 78020 | $21.32 | 1255728119 - CHANA VAN HOUTEN | 464454536 - (TX) NADIR MIR ALI MD PLLC | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $117.59 | 1477516466 - SCOTT & WHITE MEMORIAL HOSPITAL, BAYLOR SCOTT & WHITE MEDICAL CENTER - TEMPLE | 742958277 - SCOTT & WHITE CLINIC | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $71.00 | 1093783391 - CHRISTUS SPOHN HEALTH SYSTEM CORPORATION, CHRISTUS SPOHN HOSPITAL KLEBERG | 760422435 - C H WILKINSON PHYSICIAN NETWORK | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $75.69 | 1801893417 - SMITHVILLE HOSPITAL AUTHORITY, SMITHVILLE REGIONAL HOSPITAL | 741706734 | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $85.55 | 1790777696 - JACK COUNTY HOSPITAL DISTRICT, FAITH COMMUNITY HOSPITAL | 756004585 - (TX) FAITH COMMUNITY HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $51.20 | 1275581852 - ROLLING PLAINS MEMORIAL HOSPITAL | 756003896 - (TX) THE NOLAN COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $92.02 | 1346611829 - AMARI THOMAS | 300520570 - (TX) METHODIST HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $37.31 | 1295736734 - CHRISTUS HEALTH ARK-LA-TEX, CHRISTUS ST. MICHAEL HEALTH SYSTEM | 752616977 - CHRISTUS TRINITY CLINIC | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $78.33 | 1902855901 - BIG SPRING VAMC | 752510465 | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $87.80 | 1679578439 - MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, CHRISTUS MOTHER FRANCES HOSPITAL TYLER | 750818167 - (TX) MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $117.73 | 1730556259 - RAM SAHA | 541581185 - MCV ASSOCIATED PHYSICIANS | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $74.63 | 1679557888 - CHRISTUS HEALTH SOUTHEAST TEXAS, CHRISTUS SOUTHEAST TEXAS - ST. ELIZABETH | 760591590 - (TX) CHRISTUS HEALTH SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $24.10 | 1093783391 - CHRISTUS SPOHN HEALTH SYSTEM CORPORATION, CHRISTUS SPOHN HOSPITAL KLEBERG | 760422435 - C H WILKINSON PHYSICIAN NETWORK | TX | General Acute Care Hospital (282N00000X) |
United | 78020 | $58.70 | 1124076401 - DECATUR HOSPITAL AUTHORITY, WISE HEALTH SYSTEM | 751250450 - (TX) DECATUR HOSPITAL AUTHORITY | TX | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 78020 vs. Other Nuclear Medicine Procedures Codes
The CPT 78020 code is part of the Radiology Procedures services used for Nuclear Medicine Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 78020 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 78012-CPT | Low | Thyroid Uptake, Single Or Multiple Quantitative Measurement(S) (Including Stimulation, Suppression, Or Discharge, When Performed) |
| 78013-CPT | Moderate | Thyroid Imaging (Including Vascular Flow, When Performed); |
| 78014-CPT | Moderate | Thyroid Imaging (Including Vascular Flow When Performed); With Single Or Multiple Uptake(S) Quantitative Measurement(S) (Including Stimula- Tion Suppression Or Discharge When Performed) |
| 78020-CPT | Low | Thyroid Carcinoma Metastases Uptake |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78020. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78020 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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