CPT 78428 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 78428 |
National average reimbursement for CPT 78428 by major payers:
$216.76
$210.29
$206.50
$261.46
| 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 78428 | ||||||
United | 78428 | $69.01 | 1962638254 - TAMARA ZACH | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 78428 | $206.41 | 1275965964 - JUSTIN HEMMER | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 78428 | $173.10 | 1952309171 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 78428 | $320.41 | 1679912265 - CHRISTINE SOOHOO | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Emergency Medicine Physician (207P00000X) |
United | 78428 | $251.39 | 1174750335 - SAMAN SELAHI | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | OR | Internal Medicine Physician (207R00000X) |
United | 78428 | $69.01 | 1750336350 - ALARIC LEBARON | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | NV | Anesthesiology Physician (207L00000X) |
United | 78428 | $69.01 | 1821377607 - DANIEL CHOW | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | ID | Certified Registered Nurse Anesthetist (367500000X) |
United | 78428 | $251.39 | 1912986944 - JACQUELINE EUBANY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | WI | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 78428 | $32.83 | 1124057070 - NITEEN ANDALKAR | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Neurological Surgery Physician (207T00000X) |
United | 78428 | $377.14 | 1720442890 - TONY ALIAS | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78428 | $377.14 | 1396011771 - JUSTIN BECKER | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78428 | $96.54 | 1073503058 - MOHAMMAD KHALID | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | NJ | Diagnostic Radiology Physician (2085R0202X) |
United | 78428 | $274.59 | 1861650780 - CHILDRENS NATIONAL MEDICAL CENTER | 530196580 - CHILDRENS HOSPITAL | DC | Children's Hospital (282NC2000X) |
United | 78428 | $69.01 | 1972824043 - CLIFTON BURT | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | OR | Family Medicine Physician (207Q00000X) |
United | 78428 | $129.75 | 1659508570 - RAJEEV FERNANDO | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | NY | Infectious Disease Physician (207RI0200X) |
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 78428 vs. Other Nuclear Medicine Procedures Codes
The CPT 78428 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 78428 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 |
|---|---|---|
| 78414-CPT | Moderate | Determination Of Central C-V Hemodynamics (Non-Imaging) (Eg, Ejection Fraction With Probe Technique) With Or Without Pharmacologic Intervention Or Exercise, Single Or Multiple Determinations |
| 78428-CPT | Moderate | Cardiac Shunt Detection |
| 78429-CPT | Moderate | Myocardial Imaging Positron Emission Tomography (Pet) Metabolic Evaluation Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S] When Performed) Single Study; With Concurrently Acquired Computed Tomography Transmission Scan |
| 78430-CPT | Moderate | Myocardial Imaging Positron Emission Tomography (Pet) Perfusion Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S] When Performed); Single Study At Rest Or Stress (Exercise Or Pharmacologic) With Concurrently Acquired Computed Tomography Transmission Scan |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78428. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78428 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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