CPT 78431 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • ME - The order for this service adheres to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional |
| Complexity Level | High |
National average reimbursement for CPT 78431 by major payers:
$1,322.75
$2,599.82
$1,663.76
$2,310.78
| 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 78431 | ||||||
United | 78431 | $3844.92 | 1801813266 - GREGG BEAN | 741671142 - (TX) SOUTH TEXAS RADIOLOGY GROUP, P.A. | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78431 | $3744.09 | 1891162533 - CHRISTOPHER RUDD | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | TN | Family Nurse Practitioner (363LF0000X) |
United | 78431 | $3678.08 | 1801813266 - GREGG BEAN | 741671142 - (TX) SOUTH TEXAS RADIOLOGY GROUP, P.A. | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78431 | $2814.17 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78431 | $1912.96 | 1669447488 - BRADLEY NICOL | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Neurological Surgery Physician (207T00000X) |
United | 78431 | $3901.28 | 1396132239 - JORGE CHAVEZ | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Family Medicine Physician (207Q00000X) |
United | 78431 | $94.55 | 1841622008 - HUSSAIN IBRAHIM | 446005758 - OZARKS MEDICAL CENTER | FL | Interventional Cardiology Physician (207RI0011X) |
United | 78431 | $6120.31 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 78431 | $2455.87 | 1699815720 - RICARDO VICUNA | 596012065 - NORTH BROWARD HOSPITAL DISTRICT | FL | Interventional Cardiology Physician (207RI0011X) |
United | 78431 | $1446.91 | 1265519052 - RAJENDRA HIPPALGAONKAR | 593256803 - MEMORIAL HOSPITAL-WEST VOLUSIA INC | FL | Cardiovascular Disease Physician (207RC0000X) |
United | 78431 | $91.47 | 1255422267 - LOURENS WILLEKES | 560845796 - CUMBERLAND COUNTY HOSPITAL SYSTEM INC | FL | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician (208G00000X) |
United | 78431 | $5896.70 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 78431 | $75.02 | 1578988119 - MARC ISKANDAR | 593214635 - FLORIDA HOSPITAL MEDICAL GROUP INC | FL | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 78431 | $1778.90 | 1265432611 - MUTHUSAMY VELUSAMY | 475234611 - (FL) CARDIOVASCULAR INSTITUTE OF AMERICA, P.A. | FL | Interventional Cardiology Physician (207RI0011X) |
United | 78431 | $2810.84 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
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 78431 vs. Other Nuclear Medicine Procedures Codes
The CPT 78431 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 78431 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 |
| 78431-CPT | High | Myocardial Imaging Positron Emission Tomography (Pet) Perfusion Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S] When Performed); Multiple Studies At Rest And 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 78431. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78431 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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