How much does Medicare pay for CPT 78431?

Medicare allowed an average of $1606.23 per service and paid $1279.66 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $4104.01, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78431?

Nuclear medicine studies of blood flow in heart muscle at rest and with stress with concurrent ct scan. It was billed 193,996 times to 192,761 Medicare beneficiaries by 1,960 providers in 2024.

Does 78431 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1992.84 in an office setting and $84.62 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 78431 most?

Cardiology, with 126,694 services from 1,307 clinicians. Next are Interventional Cardiology, Independent Diagnostic Testing Facility (IDTF), Diagnostic Radiology.

CPT 78431

Nuclear medicine studies of blood flow in heart muscle at rest and with stress with concurrent ct scan

$1606.23Medicare-allowed amount per service, averaged across 193,996 services

Providers submitted

$4104.01

Asking price, not received

Medicare allowed

$1606.23

The fee schedule figure

Medicare paid

$1279.66

Balance is patient coinsurance

Providers submitted an average of $4104.01 for this code and Medicare allowed $1606.23 — 2.6× 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 $1279.66 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1992.84
Hospital / facility: $84.62

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. 154,692 services were billed in an office setting and 39,304 in a facility.

Services: 193,996
Beneficiaries: 192,761
Providers billing it: 1,960
Total allowed: $311,602,195

What Medicare pays for CPT 78431

Across 193,996 services billed by 1,960 providers to 192,761 beneficiaries, Medicare allowed an average of $1606.23 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 78431

Specialty	Services	Beneficiaries	Avg allowed	Providers
Cardiology	126,694	126,170	$1583.78	1,307
Interventional Cardiology	31,617	31,492	$1821.19	340
Independent Diagnostic Testing Facility (IDTF)	16,707	16,210	$2003.29	11
Diagnostic Radiology	4,904	4,896	$573.25	85
Nuclear Medicine	4,158	4,133	$737.23	64
Internal Medicine	3,910	3,895	$1042.74	70
Clinical Cardiac Electrophysiology	3,772	3,739	$2018.59	47
Advanced Heart Failure and Transplant Cardiology	1,406	1,402	$1047.74	24
Cardiac Surgery	265	265	$1237.74	2
Interventional Radiology	107	105	$80.96	1
Emergency Medicine	92	92	$2083.43	1
Nurse Practitioner	84	84	$71.24	2
Radiation Oncology	82	82	$81.21	1
Interventional Pain Management	62	62	$2200.31	1
Peripheral Vascular Disease	55	54	$2417.76	1

78431 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
Texas	28,962	$2046.56	$1624.39	238
Florida	23,381	$2153.26	$1686.09	256
California	23,023	$1827.27	$1444.19	150
Illinois	16,855	$1639.77	$1302.75	76
Pennsylvania	11,719	$1955.98	$1510.00	130
New York	9,115	$1194.05	$928.00	81
Virginia	7,825	$2333.89	$1856.84	72
Arizona	5,911	$1341.40	$1073.40	63
Nevada	5,767	$1505.58	$1199.91	55
Louisiana	5,653	$1883.91	$1490.93	64
Mississippi	5,280	$1641.30	$1305.12	54
Alabama	5,120	$1901.70	$1523.55	58
New Jersey	4,972	$1907.93	$1444.89	58
Utah	4,632	$423.68	$331.27	44
Kansas	4,567	$1260.54	$1001.71	37
Missouri	3,568	$254.99	$199.48	30
Arkansas	3,397	$493.07	$389.84	27
Georgia	2,572	$154.25	$118.13	63
Delaware	2,213	$2112.84	$1690.42	6
Ohio	2,043	$112.15	$85.68	36
Massachusetts	1,770	$239.55	$184.33	22
Oklahoma	1,475	$575.16	$444.31	20
Michigan	1,290	$221.65	$165.85	17
Tennessee	1,070	$1084.64	$851.01	24
Indiana	985	$139.87	$111.05	25
North Carolina	908	$126.61	$99.94	26
New Hampshire	866	$262.45	$206.51	14
Connecticut	862	$755.04	$597.88	32
Kentucky	805	$500.85	$385.03	24
Maryland	744	$1865.57	$1490.13	5
Minnesota	728	$240.58	$181.99	34
South Dakota	718	$82.73	$62.09	6
South Carolina	699	$2187.47	$1658.77	9
North Dakota	685	$83.59	$61.75	8
Colorado	682	$802.76	$631.36	16
Wisconsin	651	$215.94	$165.59	16
Nebraska	639	$81.39	$61.95	13
Washington	452	$1538.01	$1235.90	12
Maine	436	$86.04	$61.90	17
Vermont	337	$82.77	$62.80	5
Idaho	264	$1411.38	$1124.09	2
Iowa	203	$87.93	$66.94	7
New Mexico	116	$83.02	$65.18	6
District of Columbia	22	$2775.76	$2211.58	1
Oregon	14	$2010.57	$1601.92	1

Related codes

78452Nuclear medicine studies of heart muscle at rest and$233.43
78434Nuclear medicine study of heart muscle blood flow by pet$292.41
78492Nuclear medicine studies of blood flow in heart muscle at rest and$1331.27
78451Nuclear medicine study of heart muscle at rest and$122.96
78454Nuclear medicine studies of heart muscle at rest and$61.60
78472Nuclear medicine study of heart pumping function by labeling red blood$123.30

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.