How is CPT 78434 reimbursed?

Reimbursement for CPT 78434 varies by payer type (Medicare, Medicaid, private insurance), geographic location, and specific provider contracts. National average reimbursements for major payers like UnitedHealthcare, Cigna, Aetna, and BCBS/Anthem are available.

Healthcare providers use CPT 78434 to document and receive reimbursement for services related to moderate-level medical decision-making, including multiple diagnoses or prescription management in the context of myocardial blood flow imaging.

What factors affect the fee schedule for CPT 78434?

Factors influencing the fee schedule for CPT 78434 include government-set rates for Medicare & Medicaid, negotiated rates with private insurance companies, geographic location, and the type of provider (e.g., hospital vs. private practice).

Where can I find more information about CPT 78434?

Further details, including comparative codes and market rates, can be found on the PayerPrice platform, which compiles transparency data from various insurers. Specific Medicare rates can also be viewed.

How can I find the cost of a specific medical procedure?

To find the cost of a specific medical procedure based on a CPT code and your location, you can use online tools. For a precise estimate, consider using Payerprice, which offers a fee schedule lookup tool where you can search by CPT code and specific location. This can help you understand potential costs before receiving a service.

What is a CPT code and why is it important for understanding medical costs?

A CPT (Current Procedural Terminology) code is a standardized five-digit code used by healthcare providers to describe medical, surgical, and diagnostic services. These codes are crucial for billing and insurance purposes, providing a universal language for services rendered. Understanding the CPT code for a service can help you research its typical cost and discuss pricing with providers and insurers. Tools like Payerprice use CPT codes to help you look up specific service costs.

Does my insurance cover this medical service?

To determine if your insurance covers a specific medical service, the best course of action is to contact your insurance provider directly. Provide them with the CPT code for the service if you have it. You can also use tools like Payerprice to get an estimate of the service's cost based on your CPT code and location, which can be a valuable starting point for discussions with your insurer regarding your out-of-pocket expenses.

How do I compare prices for healthcare services in my area?

Comparing prices for healthcare services in your specific area often involves using online price transparency tools. For a comprehensive comparison based on specific CPT codes and locations, Payerprice offers a fee schedule lookup tool. This allows you to input the CPT code for a service and your location to find potential costs, helping you make more informed decisions about where to receive care.

What resources are available to help me understand my medical bills?

To understand your medical bills, several resources can be helpful. First, always contact your healthcare provider's billing department for clarification on specific charges. Second, review your Explanation of Benefits (EOB) from your insurance company, which details what services were covered and how much you owe. Additionally, to verify the typical costs associated with CPT codes listed on your bill, you can use tools like Payerprice to look up fee schedules based on your location. This can help you cross-reference charges and identify potential discrepancies.

CPT 78434 Fee Schedule

Last Verified: September 2026

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.

Absolute Quantitation Of Myoca, Absolute Quantitation Of Myocardial Blood Flow (Aqmbf) Positron Emission Tomography (Pet) Rest Andpharmacologic Stress (List Separately In Addition To Code For Primary Procedure)

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 TC - Technical component
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 78434
Medicaid Fee Schedule	View Medicaid rates for 78434

National average reimbursement for CPT 78434 by major payers:

$183.63

$94.51

$1,289.89

$282.60

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 78434.

CPT 78434

5 of 25 sample ratesHigher to lower in this preview

James Mcaleer
Poudre Valley Medical Group LLC
FLCardiovascular Disease PhysicianNPI 1205364841Tax ID 80-0348943
$196.96Published rate
Joan Siracuse
Sebring Heart Center, P.A.
FLCardiovascular Disease PhysicianNPI 1649252925Tax ID 20-2003321
$111.44Published rate
Christopher Watts
FLInternal Medicine PhysicianNPI 1306852595Tax ID 81-2336625
$40.11Published rate
Dany El-Hajjar
Pioneer Medical Group, Pl
FLInternal Medicine PhysicianNPI 1063401057Tax ID 46-3979554
$25.28Published rate
Alexander Kushnir
General Conference Of Seventh Day Adventist
FLInternal Medicine PhysicianNPI 1477970705Tax ID 93-2208118
$21.35Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 78434 vs. Other Nuclear Medicine Procedures Codes

The CPT 78434 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 78434 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
78432-CPT	High	Myocrd Img Pet 2rtracer, Myocardial Imaging Positron Emission Tomography Pet Combined Perfusion With Metabolic Evaluation Study Including Ventricular Wall Motion S And Or Ejection Fraction S When Performed Dual Radiotracer Eg Myocardial Viability
78433-CPT	High	Myocrd Img Pet 2rtracer Ct, Myocardial Imaging Positron Emission Tomography Pet Combined Perfusion With Metabolic Evaluation Study Including Ventricular Wall Motion S And Or Ejection Fraction S When Performed Dual Radiotracer Eg Myocardial Viability With Concurrently Acquired Computed Tomography Transmission Scan
78434-CPT	Low	Absolute Quantitation Of Myoca, Absolute Quantitation Of Myocardial Blood Flow (Aqmbf) Positron Emission Tomography (Pet) Rest Andpharmacologic Stress (List Separately In Addition To Code For Primary Procedure)
78451-CPT	Moderate	Ht Muscle Image Spect Sing, Myocardial Perfusion Imaging Tomographic Spect Including Attenuation Correction Qualitative Or Quantitative Wall Motion Ejection Fraction By First Pass Or Gated Technique Additional Quantification When Performed Single Study At Rest Or Stress Exercise Or Pharmacologic

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78434. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 78434 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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CPT 78434 Fee Schedule

James Mcaleer

Joan Siracuse

Christopher Watts

Dany El-Hajjar

Alexander Kushnir