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Last Verified: September 2026
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.
Pet Scan Of The Brain, The Pet (Positron Emission Tomography) Scan Creates Images By Detecting A Radioactive Substance. The Scan Evaluates Brain Function Or Blood Flow.
| 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 GZ - Item or Service Expected to Be Denied as Not Reasonable and Necessary |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 78609 |
| Medicaid Fee Schedule | View Medicaid rates for 78609 |
National average reimbursement for CPT 78609 by major payers:
$538.07
$465.30
$1,388.64
$233.79
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CPT 78609
5 of 25 sample ratesHigher to lower in this preview
Tamarah Fratianni
Northern Arizona Healthcare Corporation
$2,840.62Published rateStephen Armstrong
Radiology Associates Of North Texas, PA
$190.41Published rateJeffrey Berg
Town Center Orthopaedic Associates, P.C.
$95.24Published rateBrianne Snider
Northern Arizona Healthcare Corporation
$66.26Published rateSarah Bernstein
Town Center Orthopaedic Associates, P.C.
$0.01Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 78609 vs. Other Nuclear Medicine Procedures Codes
The CPT 78609 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 78609 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 |
|---|---|---|
| 78600-CPT | Moderate | Images Of The Brain, A Radioactive Substance Is Given By Mouth Or Iv. A Gamma Camera Creates Up To Three Images Of Brain Tissue By Detecting The Radiation. Views May Also Show Blood Flow. |
| 78605-CPT | Moderate | Images Of The Brain, A Radioactive Substance Is Given By Mouth Or Iv. A Gamma Camera Creates At Least 4 Images Of Brain Tissue By Detecting The Radiation. Views May Also Show Blood Flow. |
| 78606-CPT | Moderate | Images Of The Brain, A Radioactive Substance Is Given By Mouth Or Iv. A Gamma Camera Creates At Least 4 Images Of Brain Tissue By Detecting The Radiation. Views May Also Show Blood Flow. |
| 78609-CPT | Moderate | Pet Scan Of The Brain, The Pet (Positron Emission Tomography) Scan Creates Images By Detecting A Radioactive Substance. The Scan Evaluates Brain Function Or Blood Flow. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78609. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78609 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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