CPT 79403 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 • 19 - Off Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • Q1 - Routine clinical service provided in a clinical research study |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 79403 |
National average reimbursement for CPT 79403 by major payers:

$240.84

$239.23

$215.49

$305.15
| 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 79403 | ||||||
United | 79403 | $494.45 | 1245227735 - AJIT SHAH | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | PA | Nuclear Medicine Physician (207U00000X) |
United | 79403 | $110.94 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 79403 | $233.66 | 1003166612 - MATTHEW LILLEY | 680637976 - BEND MEMORIAL CLINIC, PC | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 79403 | $70.55 | 1679781231 - JENNIFER BURKE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | SC | Certified Registered Nurse Anesthetist (367500000X) |
United | 79403 | $131.43 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 79403 | $230.08 | 1720087513 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 79403 | $94.79 | 1700390861 - DYMAN KWARCIAK | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | FL | Hospice and Palliative Medicine (Family Medicine) Physician (207QH0002X) |
United | 79403 | $575.72 | 1548590524 - HEALTH IMAGING PARTNERS LLC | 271385885 | TX | Physiological Laboratory (293D00000X) |
United | 79403 | $165.33 | 1093775512 - ROBERT SANCHEZ | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 79403 | $165.33 | 1073838017 - CHRISTOPHER MASON | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | MI | Emergency Medicine Physician (207P00000X) |
United | 79403 | $171.00 | 1871577890 - THOMAS TAKASH | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | CA | Anesthesiology Physician (207L00000X) |
United | 79403 | $364.19 | 1376740852 - JASON LABRIE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Orthopaedic Surgery Physician (207X00000X) |
United | 79403 | $210.24 | 1700318102 - STEVEN LEE | 751286819 - (TX) RADIOLOGY ASSOCIATES OF NORTH TEXAS, PA | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 79403 | $147.83 | 1447317110 - BAPTIST HEALTH CARE, INC., BAPTIST HOME HEALT CARE AND MEDICAL EQUIPMENT | 590657322 - BAPTIST HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 79403 | $364.19 | 1023072857 - MARY ALLARE | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Neonatal-Perinatal Medicine Physician (2080N0001X) |
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 79403 vs. Other Nuclear Medicine Procedures Codes
The CPT 79403 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 79403 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 |
|---|---|---|
| 79005-CPT | Low | Radiopharmaceutical Therapy, By Oral Administration |
| 79101-CPT | Low | Radiopharmaceutical Therapy, By Intravenous Administration |
| 79200-CPT | Low | Intracavitary Radioact.Colloid Ther |
| 79403-CPT | Moderate | Radiopharaceutical Therapy Radiolabeled Monoclonal Antibody By Intravenous Infusion |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 79403. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 79403 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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