CPT 78800 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 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 78800 |
| Medicaid Fee Schedule | View Medicaid rates for 78800 |
National average reimbursement for CPT 78800 by major payers:
$264.51
$258.35
$263.02
$316.73
CPT 78800 vs. Other Nuclear Medicine Procedures Codes
The CPT 78800 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 78800 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 |
|---|---|---|
| 78800-CPT | Moderate | Rp Loclzj Tum 1 Area 1 D Img, Radiopharmaceutical Localization Of Tumor Inflammatory Process Or Distribution Of Radiopharmaceutical Agent S Includes Vascular Flow And Blood Pool Imaging When Performed Planar Single Area Eg Head Neck Chest Pelvis Single Day Imaging |
| 78801-CPT | Moderate | Rp Loclzj Tum 2 Area 1 D Img, Radiopharmaceutical Localization Of Tumor Inflammatory Process Or Distribution Of Radiopharmaceutical Agent S Includes Vascular Flow And Blood Pool Imaging When Performed Planar 2 Or More Areas Eg Abdomen And Pelvis Head And Chest 1 Or More Days Imaging Or Single Area Imaging Over 2 Or More Days |
| 78802-CPT | Moderate | Rp Loclzj Tum Whbdy 1 D Img, Radiopharmaceutical Localization Of Tumor Inflammatory Process Or Distribution Of Radiopharmaceutical Agent S Includes Vascular Flow And Blood Pool Imaging When Performed Planar Whole Body Single Day Imaging |
| 78803-CPT | Moderate | Rp Loclzj Tum Spect 1 Area, Radiopharmaceutical Localization Of Tumor Inflammatory Process Or Distribution Of Radiopharmaceutical Agent S Includes Vascular Flow And Blood Pool Imaging When Performed Tomographic Spect Single Area Eg Head Neck Chest Pelvis Or Acquisition Single Day Imaging |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78800. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78800 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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