CPT 78815 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 • PS - PET tumor subsequent treatment strategy • 26 - Professional component |
| Complexity Level | High |
National average reimbursement for CPT 78815 by major payers:
$1,187.32
$1,889.54
$1,687.01
$1,903.36
| 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 78815 | ||||||
United | 78815 | $3193.00 | 1669563417 - RION O'CONNELL | 880145500 - (NV) RADIOLOGY CONSULTANTS, LTD. | NV | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $1080.54 | 1356609234 - ELINA ZARETSKY | 542096893 | NY | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $2365.03 | 1932205077 - KAVITA ERICKSON | 351188458 | IN | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $1656.72 | 1245307719 - DAVID BALISON | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | WI | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $223.50 | 1912963208 - EDWARD STEHEL | 756002868 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $2450.00 | 1801813266 - GREGG BEAN | 741671142 - (TX) SOUTH TEXAS RADIOLOGY GROUP, P.A. | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $297.57 | 1922207026 - CHRISTOPHER JONES | 621855535 | MD | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $1997.82 | 1982390886 - YUSRA AZIZ | 756002868 | TX | Genetic Counselor (M.S.) (170300000X) |
United | 78815 | $6026.08 | 1831464551 - JEFFREY DILEO | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | PA | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $155.30 | 1639798614 - ASHLEY MACK | 756002868 | TX | Pediatrics Physician (208000000X) |
United | 78815 | $522.67 | 1316923386 - CORBIN ASBURY | 390867579 - (WI) RADIOLOGY ASSOCIATES OF THE FOX VALLEY, SC | WI | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $2878.37 | 1245272137 - FREDERIC HELLWITZ | 141338307 - (NY) ALBANY MED HEALTH SYSTEM | NY | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $3252.87 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $3193.17 | 1134165285 - JOHN BLANCO | 550492006 - WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION | WV | Diagnostic Radiology Physician (2085R0202X) |
United | 78815 | $3660.27 | 1447630728 - LINDSEY SHEA JOHNSTONE | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Diagnostic Radiology Physician (2085R0202X) |
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 78815 vs. Other Nuclear Medicine Procedures Codes
The CPT 78815 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 78815 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 |
|---|---|---|
| 78814-CPT | High | Position Emission Tomography (Pet) With Concurrently Acquired Computed Tomography (Ct) For Attenuation Correction And Anatomical Localization Imaging; Limited Area (Eg Check Head/Neck) |
| 78815-CPT | High | Position Emission Tomography (Pet) With Concurrently Acquired Computed Tomography (Ct) For Attenuation Correction And Anatomical Localization Imaging; Skull Base To Mid-Thigh |
| 78816-CPT | High | Position Emission Tomography (Pet) With Concurrently Acquired Computed Tomography (Ct) For Attenuation Correction And Anatomical Localization Imaging; Whole Body |
| 78830-CPT | Moderate | Radiopharmaceutical Localization Of Tumor Inflammatory Process Or Distribution Of Radiopharmaceutical Agent(S) (Includes Vascular Flow And Blood Pool Imaging When Performed); Tomographic (Spect) With Concurrently Acquired Computed Tomography (Ct) Transmission Scan For Anatomical Review Localization And Determination/Detection Of Pathology Single Area (Eg Head Neck Chest Pelvis Or Acquisition Singledayimaging(Desc Rvsd 1/1/23) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78815. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78815 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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