CPT 78430 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 |
| Common Modifiers | • None • 26 - Professional component • MG - The order for this service does not have appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional |
| Complexity Level | Moderate |
National average reimbursement for CPT 78430 by major payers:
$854.06
$919.94
$1,359.98
$1,790.51
| 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 78430 | ||||||
United | 78430 | $135.00 | 1568025716 - SHANE STEVENS | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | IL | Certified Registered Nurse Anesthetist (367500000X) |
United | 78430 | $159.11 | 1790002350 - KRISTOPHER DAY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | RI | Surgery Physician (208600000X) |
United | 78430 | $135.00 | 1528065919 - DAVID VAN DE WYNGAERDE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | NC | Orthopaedic Surgery Physician (207X00000X) |
United | 78430 | $34.11 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 78430 | $135.00 | 1689878530 - KATHRYN FEUQUAY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Hospitalist Physician (208M00000X) |
United | 78430 | $159.11 | 1164401592 - KENNETH BESCAK | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Cardiovascular Disease Physician (207RC0000X) |
United | 78430 | $3106.21 | 1235629825 - ALYSSA NORMAN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Psychiatry Physician (2084P0800X) |
United | 78430 | $203.00 | 1225802655 - ALEXANDER SMITH | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Physician Assistant (363A00000X) |
United | 78430 | $24.11 | 1841626322 - DANIELLE BORGERDING | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Physician Assistant (363A00000X) |
United | 78430 | $38.00 | 1518386325 - JEREMY HALL | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78430 | $159.11 | 1396278669 - JENNIFER DAVIS | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Anesthesiology Physician (207L00000X) |
United | 78430 | $24.11 | 1861641581 - JAMES KNELLER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 78430 | $24.11 | 1780930172 - RAM NARAYAN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Neurology Physician (2084N0400X) |
United | 78430 | $24.11 | 1336691815 - CAROL YACULA | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | MO | Adult Health Nurse Practitioner (363LA2200X) |
United | 78430 | $135.00 | 1942266390 - DENNIS REED | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Obstetrics & Gynecology Physician (207V00000X) |
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 78430 vs. Other Nuclear Medicine Procedures Codes
The CPT 78430 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 78430 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 78430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78430 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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