CPT 78831 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 78831 |
National average reimbursement for CPT 78831 by major payers:
$784.58
$836.27
$793.54
$1,038.40
| 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 78831 | ||||||
United | 78831 | $624.26 | 1659516169 - JESSICA COURTNEY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | MI | Certified Registered Nurse Anesthetist (367500000X) |
United | 78831 | $76.37 | 1629070529 - GREGORY LINDERER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | NV | Anesthesiology Physician (207L00000X) |
United | 78831 | $1221.01 | 1609919471 - JONATHAN MELLEN | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AK | Gastroenterology Physician (207RG0100X) |
United | 78831 | $88.11 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 78831 | $106.58 | 1821097627 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 78831 | $1071.59 | 1487161733 - MELISSA YOUNKINS | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Certified Registered Nurse Anesthetist (367500000X) |
United | 78831 | $684.37 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 78831 | $624.26 | 1750767729 - NAUMAN FAROOQ | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | PA | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
United | 78831 | $100.41 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 78831 | $1836.11 | 1871750604 - JUAN LOZANO | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Neuroradiology Physician (2085N0700X) |
United | 78831 | $1071.59 | 1144849993 - MIRANDA ANDERSON | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Hospitalist Physician (208M00000X) |
United | 78831 | $149.41 | 1326066648 - RICHARD MONTGOMERY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | KY | Surgery Physician (208600000X) |
United | 78831 | $1221.01 | 1710471750 - JESSICA FLETCHER | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Hospitalist Physician (208M00000X) |
United | 78831 | $1221.01 | 1396775227 - STEPHEN MURPHY | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Certified Registered Nurse Anesthetist (367500000X) |
United | 78831 | $1836.11 | 1396754719 - RIC BRADFORD | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | 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 78831 vs. Other Nuclear Medicine Procedures Codes
The CPT 78831 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 78831 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) |
| 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) |
| 78831-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) 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 Day(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 78831. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 78831 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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