CPT 78813 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 | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • PS - PET tumor subsequent treatment strategy |
| Complexity Level | High |
National average reimbursement for CPT 78813 by major payers:
$1,025.84
$1,776.43
$1,463.16
$1,730.52
| 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 78813 | ||||||
United | 78813 | $3354.01 | 1972800837 - MOHAN BELTHUR | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Pediatric Orthopaedic Surgery Physician (207XP3100X) |
United | 78813 | $3480.94 | 1720442890 - TONY ALIAS | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78813 | $170.10 | 1588192363 - NICOLE CHIEKA | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | NC | Gerontology Nurse Practitioner (363LG0600X) |
United | 78813 | $3354.01 | 1427248806 - ROBERT CHAVEZ | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Anesthesiology Physician (207L00000X) |
United | 78813 | $1307.42 | 1073554226 - MICHAEL SULEIMAN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Anesthesiology Physician (207L00000X) |
United | 78813 | $170.10 | 1891149043 - AUDREY LEE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Hospitalist Physician (208M00000X) |
United | 78813 | $3480.94 | 1801884606 - JAMES LOWE | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78813 | $3354.01 | 1093945081 - GINA BADESCU | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | ME | Anesthesiology Physician (207L00000X) |
United | 78813 | $119.11 | 1851390637 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 78813 | $3354.01 | 1194113399 - ELISA HILBURN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Nurse Practitioner (363L00000X) |
United | 78813 | $3229.22 | 1396754719 - RIC BRADFORD | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78813 | $3229.22 | 1548249105 - BRUCE CARTER | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78813 | $3229.22 | 1740506583 - JOSEPH SCHULTZ | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78813 | $3354.01 | 1710471750 - JESSICA FLETCHER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | NE | Hospitalist Physician (208M00000X) |
United | 78813 | $1226.43 | 1821182429 - ALLISON KIRSHNER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | ID | Nurse Practitioner (363L00000X) |
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 78813 vs. Other Nuclear Medicine Procedures Codes
The CPT 78813 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 78813 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) |
| 78813-CPT | High | Tumor Imaging, Positron Emission Tomography (Pet); Whole Body |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78813. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78813 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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