CPT 78491 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 78491 by major payers:
$873.21
$1,461.04
$1,353.77
$1,178.96
| 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 78491 | ||||||
United | 78491 | $3330.77 | 1508810573 - BAY AREA HEALTHCARE GROUP, LTD., CORPUS CHRISTI MEDICAL CENTER | 752387418 | TX | General Acute Care Hospital (282N00000X) |
United | 78491 | $1731.70 | 1083669683 - LEHIGH HMA LLC, LEHIGH REGIONAL MEDICAL CENTER | 474849671 | FL | General Acute Care Hospital (282N00000X) |
United | 78491 | $2754.43 | 1972904738 - NORTHERN VIRGINIA COMMUNITY HOSPITAL LLC, STONESPRINGS HOSPITAL CENTER | 43665595 - (VA) NORTHERN VIRGINIA COMMUNITY HOSPITAL LLC | VA | General Acute Care Hospital (282N00000X) |
United | 78491 | $1564.08 | 1902801343 - ONE STEP DIAGNOSTIC IV LP, KATY OPEN MRI | 208920243 - (TX) ONE STEP DIAGNOSTIC IV LP | TX | Radiology Clinic/Center (261QR0200X) |
United | 78491 | $1168.76 | 1669732178 - AD HOSPITAL EAST, LLC | 475587037 | TX | General Acute Care Hospital (282N00000X) |
United | 78491 | $2341.27 | 1306938071 - ADVENTIST HEALTH SYSTEM-SUNBELT, INC, ADVENTHEALTH ORLANDO | 590724459 - (FL) ADVENTIST HEALTH SYSTEM-SUNBELT INC | FL | General Acute Care Hospital (282N00000X) |
United | 78491 | $2568.13 | 1790785996 - VIRGINIA HOSPITAL CENTER ARLINGTON HEALTH SYSTEM | 540505989 - (VA) VIRGINIA HOSPITAL CENTER ARLINGTON HEALTH SYSTEM | VA | General Acute Care Hospital (282N00000X) |
United | 78491 | $1731.70 | 1770678617 - CHATTANOOGA HAMILTON COUNTY HOSPITAL AUTHORITY, ERLANGER BLEDSOE | 626000101 - ERLANGER MEDICAL CENTER | TN | Critical Access Hospital (282NC0060X) |
United | 78491 | $1900.36 | 1295772259 - LAKEVIEW MEDICAL CENTER, LLC, LAKEVIEW REGIONAL MEDICAL CENTER | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | 78491 | $3401.01 | 1881691061 - GRAHAM HOSPITAL DISTRICT, GRAHAM REGIONAL MEDICAL CENTER | 463113489 | TX | Rural Acute Care Hospital (282NR1301X) |
United | 78491 | $2538.72 | 1437341096 - ALLEN CHEN | 911012441 - (WA) SKAGIT RADIOLOGY, INC., P.S. | WA | Diagnostic Radiology Physician (2085R0202X) |
United | 78491 | $1859.25 | 1871911016 - NORTH TEXAS, MEDICAL CITY ALLIANCE | 464027347 - (TX) NORTH TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 78491 | $3330.77 | 1609860360 - OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL, ASSUMPTION COMMUNITY HOSPITAL | 721495500 - (LA) OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL | LA | Rural Acute Care Hospital (282NR1301X) |
United | 78491 | $4900.74 | 1225289895 - PROVIDENCE HEALTH & SERVICES, PROVIDENCE HOLY FAMILY HOSPITAL | 352345508 | WA | General Acute Care Hospital (282N00000X) |
United | 78491 | $85.54 | 1508153818 - ONE STEP DIAGNOSTIC VIII LP | 452601963 | TX | Radiology Clinic/Center (261QR0200X) |
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 78491 vs. Other Nuclear Medicine Procedures Codes
The CPT 78491 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 78491 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 |
|---|---|---|
| 78466-CPT | Moderate | Myocardial Imge Infarct; |
| 78468-CPT | Moderate | Nuclear Medicine Study Of Heart Muscle Following Heart Attack With Measurement Of Internal Blood Volume Ejected With Every Beat |
| 78469-CPT | Moderate | Myocardial Image Infarct; Spect |
| 78491-CPT | Moderate | Myocardial Imaging Positron Emission Tomography (Pet) Perfusion Study (Including Ventricular Wallmotion[S] And/Or Ejection Fraction[S] When Performed); Single Study At Rest Or Stress (Exercise Or Pharmacologic) (Desc Rvsd 1/1/20) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78491. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78491 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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