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 |
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 | $377.11 | 1457382483 - AMISUB OF SOUTH CAROLINA, INC., PIEDMONT MEDICAL CENTER | 953561198 - (SC) AMISUB OF SOUTH CAROLINA INC | SC | General Acute Care Hospital (282N00000X) |
United | 78472 | $46.38 | 1235771205 - AKUMIN IMAGING TEXAS LLC | 364793204 - (TX) AKUMIN INC. | TX | Radiology Clinic/Center (261QR0200X) |
United | 78472 | $441.76 | 1073576740 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE HEALTH | 860830701 | AZ | General Acute Care Hospital (282N00000X) |
United | 78472 | $866.22 | 1639177561 - SALEM MEMORIAL HOSPITAL | 436110058 - (MO) SALEM MEMORIAL HOSPITAL | MO | Critical Access Hospital (282NC0060X) |
United | 78472 | $866.22 | 1427048453 - MEDINA COUNTY HOSPITAL DISTRICT, MEDINA REGIONAL HOSPITAL | 270492434 | TX | Critical Access Hospital (282NC0060X) |
United | 78472 | $520.83 | 1689744856 - JERSEY CITY MEDICAL CENTER | 222783298 - (NJ) JERSEY CITY MEDICAL CENTER | NJ | General Acute Care Hospital (282N00000X) |
United | 78472 | $339.41 | 1083286801 - STEWARD CGH, INC. | 650638215 | FL | General Acute Care Hospital (282N00000X) |
United | 78472 | $736.26 | 1720039712 - QHG OF ENTERPRISE INC, MEDICAL CENTER ENTERPRISE | 631159023 - (AL) QHG OF ENTERPRISE INC | AL | General Acute Care Hospital (282N00000X) |
United | 78472 | $848.52 | 1619985942 - CATHOLIC HEALTH INITIATIVES COLORADO, CENTURA ST ANTHONY NORTH HOSPITAL | 840405257 - CATHOLIC HEALTH INITIATIVES COLORADO | CO | General Acute Care Hospital (282N00000X) |
United | 78472 | $171.72 | 1346631843 - MIDWEST IMAGING CENTER II, LLC | 472889709 | MO | Radiology Clinic/Center (261QR0200X) |
United | 78472 | $942.79 | 1831197508 - MERIDIAN HOSPITALS CORPORATION, BAYSHORE COMMUNITY HOSPITAL | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 78472 | $377.11 | 1255640819 - VHS OF ARROWHEAD, INC., ABRAZO ARIZONA HEART HOSPITAL | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 78472 | $594.04 | 1063426823 - MEMORIAL HEALTH SYSTEMS INC, FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER | 590973502 - MEMORIAL HEALTH SYSTEMS INC | FL | General Acute Care Hospital (282N00000X) |
United | 78472 | $342.61 | 1952560914 - BANNER BOSWELL MEDICAL CENTER | 900389314 | AZ | 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 | 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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