CPT 78597 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 78597 by major payers:

$239.83

$238.44

$232.98

$303.72
| 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 78597 | ||||||
United | 78597 | $200.33 | 1295728186 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 78597 | $147.39 | 1891774519 - LEON HOME HEALTH, LLC, LEON AT HOME | 261288029 | FL | Home Health Agency (251E00000X) |
United | 78597 | $60.59 | 1952324170 - NAVJOT SINGH | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | FL | Gastroenterology Physician (207RG0100X) |
United | 78597 | $346.79 | 1306040258 - DEREK FEUQUAY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Hospitalist Physician (208M00000X) |
United | 78597 | $177.19 | 1780941286 - MEGHAN HUGHES | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Family Medicine Physician (207Q00000X) |
United | 78597 | $30.68 | 1336551803 - KRISTI ANDREASSEN GUY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Physical Therapist (225100000X) |
United | 78597 | $176.08 | 1760801823 - SAMUEL WEIMER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Surgery Physician (208600000X) |
United | 78597 | $286.19 | 1326066648 - RICHARD MONTGOMERY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | KY | Surgery Physician (208600000X) |
United | 78597 | $145.39 | 1417908112 - CHRISTINE MCGREGOR | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Nurse Practitioner (363L00000X) |
United | 78597 | $60.59 | 1912014515 - MICHELLE EISENBERGER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | CO | Certified Registered Nurse Anesthetist (367500000X) |
United | 78597 | $60.59 | 1649237678 - ANITA EISENHART | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | NY | Emergency Medicine Physician (207P00000X) |
United | 78597 | $531.44 | 1861933954 - SABRA DIXON | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Physician Assistant (363A00000X) |
United | 78597 | $623.96 | 1487244778 - HEALTH IMAGING PARTNERS, LLC | 271385885 | TX | Physiological Laboratory (293D00000X) |
United | 78597 | $286.19 | 1376984377 - IOANA IRIME | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Emergency Medicine Physician (207P00000X) |
United | 78597 | $176.08 | 1982678322 - ZOHREH KAZEMI-DUNN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Obstetrics & Gynecology Physician (207V00000X) |
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 78597 vs. Other Nuclear Medicine Procedures Codes
The CPT 78597 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 78597 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 |
|---|---|---|
| 78579-CPT | Moderate | Pulmonary Ventilation Imaging (Eg, Aerosol Or Gas) |
| 78580-CPT | Moderate | Nuclear Medicine Study Of Blood Circulation In The Lungs |
| 78582-CPT | Moderate | Pulmonary Ventilation (Eg Aerosol Or Gas) And Perfusion Imaging (Reinstated Code Former Description Was: Nuclear Scan Of Lung;Gaseous With Ventilation Rebreathing And Washout) |
| 78597-CPT | Moderate | Quantitative Differential Pulmonary Perfusion, Including Imaging When Performed. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78597. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78597 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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