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See a sample rate comparisonCPT 78816 Fee Schedule
Medicare rates as of October 2026
CPT 78816 is classified under Radiology Procedures, in the Nuclear Medicine Procedures subgroup.
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 | PS - PET tumor subsequent treatment strategy 26 - Professional component |
| Complexity Level | High |
| Medicare Fee Schedule | $111.23 national non-facility rate (2026) · View Medicare rates for 78816 |
| Medicaid Fee Schedule | $1,241.92 median of the 7 states in the free preview · View Medicaid rates for 78816 |
National average reimbursement for CPT 78816 by major payers:
$1,111.49
BCBS / Anthem
$1,899.63
UnitedHealthcare
$1,678.55
Aetna
$1,865.10
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 78816.
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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Payer Contract Negotiation
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See a sample payer proposalCPT 78816 vs. Other Nuclear Medicine Procedures Codes
The table lists codes related to 78816. Select one to see its fee schedule.
| 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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Frequently Asked Questions
CPT 78816 reports a whole-body PET scan with concurrently acquired CT for attenuation correction and anatomical localization. Skull base to mid-thigh uses 78815, and a limited area uses 78814.
Yes, the radiopharmaceutical, such as F-18 FDG (A9552), is billed separately. Many payers also require prior authorization for PET/CT.
Imaging codes such as CPT 78816 split into a professional component (modifier 26, the physician's interpretation) and a technical component (modifier TC, the equipment, staff and supplies). A global claim covers both. A radiologist reading for a hospital usually bills only the professional component, so compare rates for the same component. Commercial rates also differ between hospital outpatient departments and freestanding imaging centers.
This page lists the rates commercial payers have published for CPT 78816 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.