CPT 78185 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 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | None 26 - Professional component 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 78185 |
| Medicaid Fee Schedule | View Medicaid rates for 78185 |
National average reimbursement for CPT 78185 by major payers:
$199.43
$202.18
$194.33
$241.49
CPT 78185 vs. Other Nuclear Medicine Procedures Codes
The CPT 78185 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 78185 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 |
|---|---|---|
| 78185-CPT | Low | Scan Of The Spleen, A Radioactive Substance Is Given By Mouth Or Iv. This Highlights The Spleen Tissue On A Scan. Blood Flow To From And Within The Organ May Also Be Viewed. |
| 78191-CPT | Low | Study Of Blood Cell Life Cycle, This Study Assesses The Health Of Platelets A Blood Component By Evaluating The Cells Life Cycle After Introducing A Radioactive Substance To A Blood Sample. |
| 78215-CPT | Moderate | Scan Of Liver And Spleen, A Radioactive Substance Is Given By Mouth Or Iv. This Highlights The Liver And Spleen On A Scan So That Their Function Is Viewed More Easily. Blood Flow Through The Organs May Be Viewed. |
| 78216-CPT | Low | Scan Of Liver And Spleen, A Radioactive Substance Is Given By Mouth Or Iv. This Highlights The Liver And Spleen On A Scan So That Their Function Is Viewed More Easily. Blood Flow Through The Organs May Be Viewed. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78185. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78185 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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