CPT 78499 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | High |
National average reimbursement for CPT 78499 by major payers:

$1,508.77

$479.97

$173.94

$695.81
| 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 78499 | ||||||
United | 78499 | $785.94 | 1093774762 - STEVENS COUNTY HOSPITAL | 481009034 - (KS) STEVENS COUNTY HOSPITAL | KS | Critical Access Hospital (282NC0060X) |
United | 78499 | $552.20 | 1275583726 - CAPITAL HEALTH SYSTEM INC, REGIONAL MEDICAL CENTER | 223548695 - (NJ) CAPITAL HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 78499 | $625.82 | 1467109488 - MOUNTAIN VISTA MEDICAL CENTER, LP | 202066363 - (AZ) MOUNTAIN VISTA MEDICAL CENTER LP | AZ | General Acute Care Hospital (282N00000X) |
United | 78499 | $576.98 | 1720033947 - ST. DAVIDS HEALTHCARE PARTNERSHIP, L.P., LLP, HEART HOSPITAL OF AUSTIN | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 78499 | $336.76 | 1235109778 - COMMUNITY HOSPITAL SOUTH, INC., COMMUNITY HOSPITAL SOUTH | 351088640 - COMMUNITY HOSPITALS OF INDIANA INC | IN | General Acute Care Hospital (282N00000X) |
United | 78499 | $386.54 | 1508859661 - MERCY HOSPITAL JEFFERSON, JEFFERSON MEMORIAL HOSPITAL ASSOCIATION | 430687077 - (MO) MERCY HOSPITAL JEFFERSON | MO | General Acute Care Hospital (282N00000X) |
United | 78499 | $339.41 | 1083286801 - STEWARD CGH, INC. | 650638215 | FL | General Acute Care Hospital (282N00000X) |
United | 78499 | $250.16 | 1548750417 - UKHS GREAT BEND, LLC, THE UNIVERSITY OF KANSAS HEALTH SYSTEM GREAT BEND CAMPUS | 830516935 | KS | General Acute Care Hospital (282N00000X) |
United | 78499 | $699.61 | 1487607784 - NORTHWEST HOSPITAL LLC, NORTHWEST MEDICAL CENTER | 621762430 | AZ | General Acute Care Hospital (282N00000X) |
United | 78499 | $552.20 | 1275583726 - CAPITAL HEALTH SYSTEM INC, REGIONAL MEDICAL CENTER | 223548695 - (NJ) CAPITAL HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 78499 | $250.16 | 1548750417 - UKHS GREAT BEND, LLC, THE UNIVERSITY OF KANSAS HEALTH SYSTEM GREAT BEND CAMPUS | 830516935 | KS | General Acute Care Hospital (282N00000X) |
United | 78499 | $625.82 | 1609345685 - MOUNTAIN VISTA MEDICAL CENTER, LP, FLORENCE HOSPITAL, A CAMPUS OF MOUNTAIN VISTA MEDICAL CENTER | 202066363 - (AZ) MOUNTAIN VISTA MEDICAL CENTER LP | AZ | General Acute Care Hospital (282N00000X) |
United | 78499 | $594.04 | 1275511651 - ADVENTIST HEALTH SYSTEM-SUNBELT INC, ADVENTHEALTH LAB | 590725553 - (FL) ADVENTIST HEALTH SYSTEM-SUNBELT INC | FL | Critical Access Hospital (282NC0060X) |
United | 78499 | $866.22 | 1427048453 - MEDINA COUNTY HOSPITAL DISTRICT, MEDINA REGIONAL HOSPITAL | 270492434 | TX | Critical Access Hospital (282NC0060X) |
United | 78499 | $783.71 | 1770598104 - KENMORE MERCY HOSPITAL | 160762843 - (NY) KENMORE MERCY HOSPITAL | NY | 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 78499 vs. Other Nuclear Medicine Procedures Codes
The CPT 78499 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 78499 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 |
| 78499-CPT | High | Unlisted Cardiovascular Procedure, Diagnostic Nuclear Medicine |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78499. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78499 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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