CPT 78804 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 78804 by major payers:
$664.16
$698.10
$706.28
$862.79
| 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 78804 | ||||||
United | 78804 | $922.78 | 1710471750 - JESSICA FLETCHER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Hospitalist Physician (208M00000X) |
United | 78804 | $1357.93 | 1598730061 - ANGELA LAMPKIN | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78804 | $91.19 | 1972122844 - CAMERON ALLEN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Physician Assistant (363A00000X) |
United | 78804 | $535.90 | 1760706238 - STEPHENSON IKPE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | GA | Orthopaedic Surgery Physician (207X00000X) |
United | 78804 | $578.85 | 1710210273 - JENNIFER FAIRCLOTH | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | WA | Certified Registered Nurse Anesthetist (367500000X) |
United | 78804 | $91.19 | 1194757427 - ROBERT TIBALLI | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | TN | Hospitalist Physician (208M00000X) |
United | 78804 | $922.78 | 1487034039 - GREGORY DUHON | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | LA | Internal Medicine Physician (207R00000X) |
United | 78804 | $91.19 | 1851818561 - AUBREY STUBLER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Speech-Language Pathologist (235Z00000X) |
United | 78804 | $831.59 | 1275868788 - RIANNE PAGE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Emergency Medicine Physician (207P00000X) |
United | 78804 | $91.19 | 1780947937 - GURJEET SINGH | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | ID | Neurology Physician (2084N0400X) |
United | 78804 | $922.78 | 1518373901 - APRIL SCHLEIER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Nurse Practitioner (363L00000X) |
United | 78804 | $756.57 | 1396010856 - BERTRAND LIANG | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | KS | Neurology Physician (2084N0400X) |
United | 78804 | $91.19 | 1205182284 - SHAHID AHMAD | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | MI | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
United | 78804 | $578.85 | 1285703215 - JAMES HAYES | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Emergency Medicine Physician (207P00000X) |
United | 78804 | $922.78 | 1669457206 - ANANYA DAS | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Gastroenterology Physician (207RG0100X) |
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 78804 vs. Other Nuclear Medicine Procedures Codes
The CPT 78804 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 78804 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 | 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 (Desc Rvsd 1/1/20) |
| 78801-CPT | Moderate | Radiopharmaceutical Localization Of Tumor Inflamm-Atory Process Or Distribution Of Radiopharmaceuti-Cal 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 (Desc Rvsd 1/1/20) |
| 78802-CPT | Moderate | Radiopharmaceutical Localization Of Tumor Inflamm-Atory Process Or Distribution Of Radiopharmaceuti-Cal Agent(S) (Includes Vascular Flow And Blood Pool Imaging When Performed); Planar Whole Body Single Day Imaging (Desc Rvsd 1/1/20) |
| 78804-CPT | Moderate | Radiopharmaceutical Localization Of Tumor Inflamm-Atory Process Or Distribution Of Radiopharmaceuti-Cal Agent(S) (Includes Vascular Flow And Blood Pool Imaging When Performed); Planar Whole Body Requiring 2 Or More Days Imaging (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 78804. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78804 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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