How much does Medicare pay for CPT 78226?

Medicare allowed an average of $40.73 per service and paid $31.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $226.13, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78226?

Nuclear medicine study of liver and bile duct system. It was billed 19,469 times to 19,215 Medicare beneficiaries by 847 providers in 2024.

Does 78226 pay differently in an office than a hospital?

Yes. The allowed amount averaged $234.53 in an office setting and $34.45 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 78226 most?

Diagnostic Radiology, with 15,369 services from 720 clinicians. Next are Nuclear Medicine, Interventional Radiology, Internal Medicine.

CPT 78226

Nuclear medicine study of liver and bile duct system

$40.73Medicare-allowed amount per service, averaged across 19,469 services

Providers submitted

$226.13

Asking price, not received

Medicare allowed

$40.73

The fee schedule figure

Medicare paid

$31.27

Balance is patient coinsurance

Providers submitted an average of $226.13 for this code and Medicare allowed $40.73 — 5.6× 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 $31.27 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $234.53
Hospital / facility: $34.45

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. 611 services were billed in an office setting and 18,858 in a facility.

Services: 19,469
Beneficiaries: 19,215
Providers billing it: 847
Total allowed: $792,972

What Medicare pays for CPT 78226

Across 19,469 services billed by 847 providers to 19,215 beneficiaries, Medicare allowed an average of $40.73 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 78226

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	15,369	15,181	$40.02	720
Nuclear Medicine	3,527	3,472	$43.47	101
Interventional Radiology	512	502	$34.65	21
Internal Medicine	23	23	$125.05	2
Geriatric Medicine	13	13	$34.30	1
Independent Diagnostic Testing Facility (IDTF)	13	12	$234.19	1
Family Practice	12	12	$38.03	1

78226 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	3,191	$43.16	$30.86	117
Florida	2,247	$63.51	$49.45	94
New York	1,680	$40.68	$28.84	69
Texas	1,207	$33.34	$26.30	48
New Jersey	1,113	$42.57	$30.49	46
Michigan	847	$33.88	$25.45	30
Pennsylvania	808	$34.07	$26.47	40
Ohio	758	$37.44	$28.24	28
Illinois	710	$40.71	$32.58	34
Tennessee	619	$36.37	$28.89	34
Virginia	565	$33.66	$26.35	27
Missouri	564	$33.09	$26.20	25
Indiana	449	$32.71	$25.17	22
Georgia	433	$33.37	$25.80	20
North Carolina	408	$39.53	$31.05	21
Arizona	388	$33.20	$25.96	16
Mississippi	321	$32.36	$26.48	12
Massachusetts	307	$35.06	$26.80	18
Connecticut	301	$35.93	$26.19	12
Maryland	277	$50.37	$36.78	14
Washington	265	$34.96	$26.19	11
Alabama	211	$32.39	$25.11	15
Arkansas	187	$32.36	$26.61	12
Kentucky	163	$33.51	$26.32	9
Louisiana	141	$32.75	$26.38	8
Oregon	136	$34.65	$27.08	5
Wisconsin	131	$33.03	$25.13	6
South Dakota	115	$32.96	$24.39	5
Delaware	111	$33.95	$27.07	4
New Mexico	111	$34.45	$25.63	4
Oklahoma	108	$32.47	$25.96	7
Minnesota	92	$35.99	$24.73	4
Nebraska	79	$65.42	$52.62	5
Colorado	70	$33.64	$26.33	4
Rhode Island	65	$34.37	$25.87	4
Nevada	60	$32.74	$25.54	4
South Carolina	51	$33.40	$27.06	3
Iowa	38	$32.56	$26.41	1
West Virginia	31	$32.85	$23.77	2
Kansas	29	$31.91	$27.06	2
Hawaii	20	$34.16	$26.96	1
District of Columbia	20	$36.88	$25.75	1
New Hampshire	15	$33.66	$25.17	1
AA	14	$31.19	$27.44	1
Idaho	13	$32.20	$27.08	1

Related codes

78264Nuclear medicine study of stomach to assess emptying$67.25
78227Nuclear medicine study of liver and bile duct system$83.03
78278Nuclear medicine study to assess blood loss$45.76

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.