How much does Medicare pay for CPT 78227?

Medicare allowed an average of $83.03 per service and paid $64.14 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $384.86, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78227?

Nuclear medicine study of liver and bile duct system with use of drugs. It was billed 20,176 times to 19,999 Medicare beneficiaries by 864 providers in 2024.

Does 78227 pay differently in an office than a hospital?

Yes. The allowed amount averaged $336.01 in an office setting and $40.22 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 78227 most?

Diagnostic Radiology, with 16,866 services from 749 clinicians. Next are Nuclear Medicine, Interventional Radiology, Independent Diagnostic Testing Facility (IDTF).

CPT 78227

Nuclear medicine study of liver and bile duct system with use of drugs

$83.03Medicare-allowed amount per service, averaged across 20,176 services

Providers submitted

$384.86

Asking price, not received

Medicare allowed

$83.03

The fee schedule figure

Medicare paid

$64.14

Balance is patient coinsurance

Providers submitted an average of $384.86 for this code and Medicare allowed $83.03 — 4.6× 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 $64.14 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $336.01
Hospital / facility: $40.22

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. 2,920 services were billed in an office setting and 17,256 in a facility.

Services: 20,176
Beneficiaries: 19,999
Providers billing it: 864
Total allowed: $1,675,213

What Medicare pays for CPT 78227

Across 20,176 services billed by 864 providers to 19,999 beneficiaries, Medicare allowed an average of $83.03 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 78227

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	16,866	16,725	$75.87	749
Nuclear Medicine	2,526	2,516	$94.15	76
Interventional Radiology	377	372	$68.50	19
Independent Diagnostic Testing Facility (IDTF)	297	276	$327.88	13
Family Practice	40	40	$335.70	2
Internal Medicine	18	18	$349.34	1
Pediatric Medicine	16	16	$363.70	1
Radiation Oncology	13	13	$369.72	1
Psychiatry	12	12	$37.43	1
Nurse Practitioner	11	11	$344.26	1

78227 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
Florida	1,938	$136.71	$109.91	81
Texas	1,580	$104.84	$82.71	65
California	1,378	$73.94	$54.10	59
Pennsylvania	893	$59.22	$46.47	35
Illinois	814	$58.32	$45.54	30
Virginia	770	$46.04	$36.42	32
Ohio	731	$47.00	$36.38	29
Maryland	723	$165.49	$122.05	20
North Carolina	712	$106.35	$88.89	26
Tennessee	638	$79.79	$69.25	24
South Carolina	631	$51.99	$41.86	33
Missouri	615	$61.36	$51.12	29
Georgia	564	$58.58	$46.80	27
Arkansas	541	$38.27	$31.83	17
Arizona	539	$150.12	$119.20	27
New York	533	$164.54	$109.79	21
Mississippi	523	$78.39	$69.56	25
Michigan	443	$58.10	$46.81	20
Colorado	428	$61.19	$46.12	12
Louisiana	397	$39.59	$32.18	19
Oklahoma	371	$39.70	$30.46	18
Kentucky	334	$39.67	$31.52	15
Massachusetts	304	$186.38	$148.34	10
Alabama	295	$63.20	$54.50	16
Iowa	293	$54.33	$45.07	14
Washington	280	$60.56	$44.33	13
Indiana	280	$53.50	$43.88	14
Kansas	258	$39.00	$31.80	17
New Jersey	238	$43.98	$32.21	11
Minnesota	236	$40.46	$32.56	11
West Virginia	202	$39.05	$31.02	13
Wisconsin	181	$38.51	$31.56	8
Nevada	177	$203.55	$168.04	12
Nebraska	152	$105.09	$89.72	8
New Mexico	152	$40.42	$29.83	4
Rhode Island	142	$40.25	$32.41	4
Delaware	136	$130.78	$104.38	7
Utah	113	$39.16	$30.38	5
Connecticut	111	$165.25	$131.29	3
Idaho	105	$38.89	$31.68	6
Oregon	98	$66.18	$53.06	5
District of Columbia	93	$44.14	$31.97	3
New Hampshire	67	$39.66	$30.43	5
South Dakota	65	$40.69	$32.12	5
Montana	52	$40.76	$29.61	3
North Dakota	39	$39.65	$30.19	2
Alaska	11	$55.61	$30.09	1

Related codes

78264Nuclear medicine study of stomach to assess emptying$67.25
78226Nuclear medicine study of liver and bile duct system$40.73
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.