How much does Medicare pay for CPT 78195?

Medicare allowed an average of $62.83 per service and paid $48.92 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $356.94, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78195?

Nuclear medicine study of lymphatic system. It was billed 10,506 times to 10,467 Medicare beneficiaries by 502 providers in 2024.

Does 78195 pay differently in an office than a hospital?

Yes. The allowed amount averaged $231.14 in an office setting and $54.88 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 78195 most?

Diagnostic Radiology, with 6,731 services from 344 clinicians. Next are Nuclear Medicine, Interventional Radiology, General Surgery.

CPT 78195

Nuclear medicine study of lymphatic system

$62.83Medicare-allowed amount per service, averaged across 10,506 services

Providers submitted

$356.94

Asking price, not received

Medicare allowed

$62.83

The fee schedule figure

Medicare paid

$48.92

Balance is patient coinsurance

Providers submitted an average of $356.94 for this code and Medicare allowed $62.83 — 5.7× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $48.92 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $231.14
Hospital / facility: $54.88

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 474 services were billed in an office setting and 10,032 in a facility.

Services: 10,506
Beneficiaries: 10,467
Providers billing it: 502
Total allowed: $660,092

What Medicare pays for CPT 78195

Across 10,506 services billed by 502 providers to 10,467 beneficiaries, Medicare allowed an average of $62.83 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 78195

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	6,731	6,710	$60.91	344
Nuclear Medicine	3,104	3,088	$64.02	125
Interventional Radiology	304	303	$72.78	15
General Surgery	195	195	$76.81	9
Surgical Oncology	60	60	$57.16	3
Physician Assistant	50	49	$46.32	2
Independent Diagnostic Testing Facility (IDTF)	21	21	$303.63	1
Radiation Oncology	15	15	$48.55	1
Preventive Medicine	13	13	$61.92	1
Nurse Practitioner	13	13	$44.13	1

78195 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	1,285	$99.05	$69.91	62
Florida	1,174	$54.78	$41.59	52
Texas	1,000	$59.28	$46.15	40
New York	835	$58.75	$41.85	35
Illinois	674	$68.45	$52.97	30
North Carolina	446	$52.17	$41.59	24
Virginia	395	$53.50	$41.58	19
Pennsylvania	376	$55.21	$41.22	22
Missouri	357	$52.85	$41.90	15
Maryland	347	$56.38	$41.88	16
Massachusetts	286	$56.64	$41.97	17
Michigan	238	$54.76	$39.65	13
Ohio	231	$53.37	$41.10	13
South Carolina	209	$53.22	$41.77	10
Mississippi	207	$51.23	$42.57	6
Tennessee	197	$51.80	$41.02	10
Washington	187	$55.66	$41.31	10
New Jersey	186	$85.76	$61.17	7
Georgia	160	$54.47	$41.55	8
Alabama	146	$52.17	$40.51	8
Indiana	139	$51.56	$41.29	3
Wisconsin	121	$51.68	$41.80	6
New Mexico	119	$55.45	$38.85	2
Colorado	105	$54.44	$41.95	6
Kentucky	99	$52.90	$42.69	5
Rhode Island	97	$55.18	$42.30	4
Arkansas	84	$86.47	$72.28	6
District of Columbia	81	$57.23	$39.99	5
Arizona	79	$54.14	$41.97	6
North Dakota	67	$52.79	$42.64	3
Kansas	59	$181.15	$155.27	4
Oklahoma	53	$52.09	$42.67	4
Montana	53	$48.46	$38.80	3
Minnesota	46	$52.54	$42.71	1
Connecticut	44	$57.25	$41.78	3
Oregon	38	$58.61	$41.64	3
Louisiana	37	$52.64	$41.98	3
Nebraska	35	$51.13	$40.33	2
West Virginia	34	$54.15	$41.86	2
Hawaii	29	$54.43	$41.11	2
Iowa	29	$52.70	$41.36	2
Utah	24	$47.66	$37.79	2
Delaware	23	$53.76	$42.65	2
New Hampshire	23	$54.12	$41.32	2
Puerto Rico	15	$51.70	$39.93	1
Idaho	13	$51.51	$42.65	1
Nevada	12	$53.41	$42.80	1
AA	12	$51.36	$42.74	1

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.