CPT 78472 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 • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 78472 |
National average reimbursement for CPT 78472 by major payers:
$258.80
$277.15
$277.41
$338.08
| 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 78472 | ||||||
United | 78472 | $306.48 | 1013382860 - LARKIN COMMUNITY HOSPITAL PALM SPRINGS CAMPUS, LLC | 475625607 | FL | General Acute Care Hospital (282N00000X) |
United | 78472 | $377.11 | 1013386143 - EOH ACQUISITION GROUP, LLC, CAREWELL HEALTH MEDICAL CENTER | 854153331 - (NJ) EOH ACQUISITIONS GROUP, LLC DBA CAREWELL HEALTH | NJ | General Acute Care Hospital (282N00000X) |
United | 78472 | $615.97 | 1811994809 - AHS HOSPITAL CORP., CHILTON MEDICAL CENTER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 78472 | $736.26 | 1073601043 - HH HEALTH SYSTEM, RED BAY HOSPITAL | 472323163 - (AL) HH HEALTH SYSTEM | AL | Critical Access Hospital (282NC0060X) |
United | 78472 | $368.13 | 1326187097 - SHRINERS HOSPITALS FOR CHILDREN | 362193608 - SHRINERS HOSPITALS FOR CHILDREN | SC | Children's Hospital (282NC2000X) |
United | 78472 | $258.73 | 1346619129 - BLANCA LOPEZ | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Physician Assistant (363A00000X) |
United | 78472 | $388.83 | 1518454842 - ROCK REGIONAL HOSPITAL, LLC, ROCK REGIONAL HOSPITAL | 814594719 - (KS) ROCK REGIONAL HOSPITAL LLC | KS | General Acute Care Hospital (282N00000X) |
United | 78472 | $848.52 | 1821042979 - HCA HEALTHONE LLC, NORTH SUBURBAN MEDICAL CENTER | 841321373 | CO | General Acute Care Hospital (282N00000X) |
United | 78472 | $736.26 | 1356692297 - H H HEALTH SYSTEM-MORGAN LLC, DECATUR MORGAN HOSPITAL-DECATUR CAMPUS | 460928982 | AL | General Acute Care Hospital (282N00000X) |
United | 78472 | $377.11 | 1275235426 - EMERUS BHS SA THOUSAND OAKS LLC | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 78472 | $603.39 | 1134278435 - SCOTT REGIONAL MEDICAL CENTER, INC., OCHSNER SCOTT REGIONAL | 260792328 - (MS) SCOTT REGIONAL MEDICAL CENTER INC | MS | Critical Access Hospital (282NC0060X) |
United | 78472 | $471.73 | 1417471467 - WEATHERFORD HEALTH SERVICES, LLC, MEDICAL CITY WEATHERFORD | 822073410 - (TX) WEATHERFORD HEALTH SERVICES LLC | TX | General Acute Care Hospital (282N00000X) |
United | 78472 | $456.10 | 1902836943 - DLP CENTRAL CAROLINA MEDICAL CENTER LLC, CENTRAL CAROLINA HOSPITAL | 810691912 | NC | General Acute Care Hospital (282N00000X) |
United | 78472 | $201.94 | 1255112694 - MEGAN WETZEL | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Physician Assistant (363A00000X) |
United | 78472 | $1058.71 | 1528006103 - BRYAN MEDICAL CENTER | 470376552 - BRYAN MEDICAL CENTER | NE | General Acute Care Hospital (282N00000X) |
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 78472 vs. Other Nuclear Medicine Procedures Codes
The CPT 78472 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 78472 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 |
|---|---|---|
| 78472-CPT | Moderate | Cardiac Blood Pool Imaging, Gated Equilibrium; Planar, Single Study At Rest Or Stress (Exercise And/Or Pharmacologic), Wall Motion Study Plus Ejection Fraction, With Or Without Additional Quantitative Processing |
| 78473-CPT | Moderate | Cardiac Blood Pool Imaging, Gated Equilibrium; Multiple Studies, Wall Motion Study Plus Ejection Fraction, At Rest And Stress (Exercise And/Or Pharmacologic), With Or Without Additional Quantification |
| 78481-CPT | Moderate | Cardiac Blood Pool Imaging (Planar), First Pass Technique; Single Study, At Rest Or With Stress (Exercise And/Or Pharmacologic), Wall Motion Study Plus Ejection Fraction, With Or Without Quantification |
| 78483-CPT | Moderate | Cardiac Blood Pool Imaging (Planar), First Pass Technique; Multiple Studies, At Rest And With Stress (Exercise And/Or Pharmacologic), Wall Motion Study Plus Ejection Fraction, With Or Without Quantification |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78472. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78472 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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