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See a sample rate comparisonCPT 78431 Fee Schedule
Last Verified: September 2026
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.
Myocrd Img Pet Rst Strs Ct, 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
| 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 |
| Medicare Fee Schedule | View Medicare rates for 78431 |
| Medicaid Fee Schedule | View Medicaid rates for 78431 |
National average reimbursement for CPT 78431 by major payers:
$1,322.75
$2,599.82
$1,663.76
$2,182.44
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CPT 78431
5 of 25 sample ratesHigher to lower in this preview
Matthew Lilley
Bend Memorial Clinic, PC
$6,335.79Published ratePhillip Habib
$3,015.81Published rateRafle Fernandez
$1,831.18Published rateFrancis Le
Catawba Valley Medical Group Inc
$131.85Published rateAurelio Reyes
Childrens Hospital Medical Practice Corp
$56.31Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 | Heart Blood Flow Study, A Radioactive Substance Is Injected Into The Bloodstream. A Camera Records The Isotopes As They Flow Through One Full Heart Cycle. This Is One Method For Measuring The Physical Forces That Influence Blood Flow. |
| 78428-CPT | Moderate | Scan Of Heart Blood Flow, A Radioactive Substance Is Given By Mouth Or Iv. This Highlights Blood Flow In The Heart On A Scan So That Any Abnormal Passage Between Blood Vessels (Cardiac Shunt) May Be Viewed More Easily. |
| 78429-CPT | Moderate | Myocrd Img Pet 1 Std W Ct, 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 | Myocrd Img Pet Rst Strs Ct, 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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