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See a sample rate comparisonCPT 78431 Fee Schedule
Medicare rates as of October 2026
CPT 78431 is classified under Radiology Procedures, in the Nuclear Medicine Procedures subgroup.
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 | 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 | $86.51 national non-facility rate (2026) · View Medicare rates for 78431 |
| Medicaid Fee Schedule | $1,264.56 median of the 7 states in the free preview · View Medicaid rates for 78431 |
National average reimbursement for CPT 78431 by major payers:
$1,322.75
BCBS / Anthem
$2,599.82
UnitedHealthcare
$1,663.76
Aetna
$2,182.44
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 78431.
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 table lists codes related to 78431. Select one to see its fee schedule.
| 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for accurate billing and processing of claims by insurance companies.
To find the specific cost of a medical procedure or service, especially when searching by CPT code and your specific location, you should use a tool designed for this purpose. We recommend Payerprice, which offers a fee schedule lookup tool allowing you to search for costs based on CPT codes and geographical location. This can provide more tailored and accurate information than general resources.
No, insurance typically does not cover all medical costs. Most insurance plans have deductibles, co-payments, and co-insurance that you are responsible for paying. Additionally, some services may not be covered at all, or only partially, depending on your plan's benefits, medical necessity, and whether the provider is in-network. It's always best to check with your insurance provider directly regarding specific coverage details.
A fee schedule is a complete listing of fees used by health plans to pay doctors or other providers for specific medical services. It specifies the maximum dollar amount that an insurer will reimburse a provider for a particular service, procedure, or supply. These schedules are often based on CPT codes and can vary by region and insurer. Tools like Payerprice can help you understand these schedules.
To effectively compare prices for medical services, especially for specific procedures identified by CPT codes and in your particular area, we recommend using Payerprice. Their fee schedule lookup tool allows you to search for and compare costs based on CPT code and specific location, helping you make informed decisions about healthcare expenses.