How much does Medicare pay for CPT 78434?

Medicare allowed an average of $292.41 per service and paid $233.47 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $591.48, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78434?

Nuclear medicine study of heart muscle blood flow by pet. It was billed 158,810 times to 157,819 Medicare beneficiaries by 1,556 providers in 2024.

Does 78434 pay differently in an office than a hospital?

Yes. The allowed amount averaged $353.08 in an office setting and $27.99 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 78434 most?

Cardiology, with 105,321 services from 1,095 clinicians. Next are Interventional Cardiology, Independent Diagnostic Testing Facility (IDTF), Clinical Cardiac Electrophysiology.

CPT 78434

Nuclear medicine study of heart muscle blood flow by pet

$292.41Medicare-allowed amount per service, averaged across 158,810 services

Providers submitted

$591.48

Asking price, not received

Medicare allowed

$292.41

The fee schedule figure

Medicare paid

$233.47

Balance is patient coinsurance

Providers submitted an average of $591.48 for this code and Medicare allowed $292.41 — 2.0× 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 $233.47 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $353.08
Hospital / facility: $27.99

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. 129,171 services were billed in an office setting and 29,639 in a facility.

Services: 158,810
Beneficiaries: 157,819
Providers billing it: 1,556
Total allowed: $46,437,632

What Medicare pays for CPT 78434

Across 158,810 services billed by 1,556 providers to 157,819 beneficiaries, Medicare allowed an average of $292.41 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 78434

Specialty	Services	Beneficiaries	Avg allowed	Providers
Cardiology	105,321	104,956	$287.08	1,095
Interventional Cardiology	23,288	23,222	$403.35	256
Independent Diagnostic Testing Facility (IDTF)	16,028	15,535	$267.45	7
Clinical Cardiac Electrophysiology	3,792	3,765	$318.15	45
Nuclear Medicine	3,467	3,443	$71.15	42
Diagnostic Radiology	2,775	2,769	$69.77	38
Internal Medicine	2,601	2,593	$170.99	50
Advanced Heart Failure and Transplant Cardiology	1,133	1,131	$324.45	17
Cardiac Surgery	121	121	$30.47	1
Emergency Medicine	92	92	$563.04	1
Radiation Oncology	83	83	$26.44	1
Nurse Practitioner	69	69	$23.46	1
Osteopathic Manipulative Medicine	24	24	$122.29	1
Hospitalist	16	16	$31.39	1

78434 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	24,727	$130.17	$103.23	136
Texas	19,548	$520.32	$413.20	201
Florida	19,097	$488.78	$383.18	213
Illinois	13,415	$252.09	$200.78	53
Pennsylvania	10,590	$504.67	$390.30	117
New York	10,338	$113.45	$87.96	82
Louisiana	5,462	$520.18	$408.63	51
Nevada	5,271	$120.47	$96.70	40
New Jersey	4,813	$427.19	$342.81	67
Utah	4,393	$49.22	$38.59	44
Kansas	4,384	$102.46	$81.34	37
Virginia	3,778	$453.89	$361.28	39
Georgia	3,732	$43.98	$34.24	58
Arizona	3,356	$82.63	$66.68	46
Mississippi	3,288	$547.36	$433.42	36
Missouri	3,109	$30.76	$23.86	27
Maryland	2,580	$505.77	$405.82	22
Delaware	2,224	$616.69	$495.19	6
Massachusetts	1,602	$29.76	$21.32	19
Arkansas	1,379	$125.86	$100.27	10
Tennessee	1,261	$28.25	$22.56	43
Michigan	1,250	$40.96	$31.58	14
Ohio	1,187	$29.18	$22.59	21
Alabama	869	$124.23	$93.89	14
New Hampshire	814	$37.85	$29.84	13
South Dakota	710	$27.25	$21.15	6
Indiana	697	$29.33	$23.75	12
North Dakota	666	$27.54	$20.91	8
Colorado	557	$150.54	$118.33	16
Washington	537	$103.37	$82.85	14
Minnesota	515	$27.94	$21.65	25
North Carolina	425	$26.88	$21.58	11
Maine	422	$28.23	$21.34	16
Connecticut	406	$36.62	$27.64	15
Oregon	389	$125.34	$100.30	5
Vermont	325	$27.41	$21.22	4
Idaho	263	$106.33	$84.72	2
Oklahoma	184	$194.75	$155.42	4
Wisconsin	105	$123.87	$99.91	3
District of Columbia	83	$228.41	$181.39	2
Iowa	30	$94.49	$77.34	2
Kentucky	29	$28.52	$19.95	2

Related codes

78452Nuclear medicine studies of heart muscle at rest and$233.43
78431Nuclear medicine studies of blood flow in heart muscle at rest and$1606.23
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.