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See a sample rate comparisonCPT 78816 Fee Schedule
Last Verified: September 2026
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.
Pet Scan With Ct Scan, A Pet (Positron Emission Tomography) Scan Creates Images By Detecting A Radioactive Substance That Has Been Given By Mouth Or Iv. A Ct (Computed Tomography) Scan May Be Superimposed For Enhanced Views.
| 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 |
| Medicare Fee Schedule | View Medicare rates for 78816 |
| Medicaid Fee Schedule | View Medicaid rates for 78816 |
National average reimbursement for CPT 78816 by major payers:
$1,111.49
$1,899.63
$1,678.55
$1,865.10
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CPT 78816
5 of 25 sample ratesHigher to lower in this preview
Terri Williams-Weekes
Tmc Radiology Cra LLC
$3,867.23Published rateEric Padron
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$1,842.90Published rateMichael Hauk
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$1,706.93Published rateGamaliel Rodriguez-Herrera
$216.11Published rateGrethe Mortenson
Froedtert South Inc
$106.38Published rate
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See a sample payer proposalCPT 78816 vs. Other Nuclear Medicine Procedures Codes
The CPT 78816 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 78816 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 | Pet Scan With Ct Scan, A Pet (Positron Emission Tomography) Scan Creates Images By Detecting A Radioactive Substance That Has Been Given By Mouth Or Iv. A Ct (Computed Tomography) Scan May Be Superimposed For Enhanced Views. |
| 78815-CPT | High | Pet Scan With Ct Scan, A Pet (Positron Emission Tomography) Scan Creates Images By Detecting A Radioactive Substance That Has Been Given By Mouth Or Iv. A Ct (Computed Tomography) Scan May Be Superimposed For Enhanced Views. |
| 78816-CPT | High | Pet Scan With Ct Scan, A Pet (Positron Emission Tomography) Scan Creates Images By Detecting A Radioactive Substance That Has Been Given By Mouth Or Iv. A Ct (Computed Tomography) Scan May Be Superimposed For Enhanced Views. |
| 78832-CPT | High | Rp Loclzj Tum Spect W Ct 2, 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 Minimum 2 Areas Eg Pelvis And Knees Chest And Abdomen Or Separate Acquisitions Eg Lung Ventilation And Perfusion Single Day Imaging Or Single Area Or Acquisition Over 2 Or More Days |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 78816. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78816 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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