How much does Medicare pay for CPT 78451?

Medicare allowed an average of $122.96 per service and paid $92.94 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $416.12, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78451?

Nuclear medicine study of heart muscle at rest and with stress and spect. It was billed 13,321 times to 13,064 Medicare beneficiaries by 297 providers in 2024.

Does 78451 pay differently in an office than a hospital?

Yes. The allowed amount averaged $282.05 in an office setting and $63.21 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 78451 most?

Cardiology, with 7,563 services from 168 clinicians. Next are Diagnostic Radiology, Nuclear Medicine, Internal Medicine.

CPT 78451

Nuclear medicine study of heart muscle at rest and with stress and spect

$122.96Medicare-allowed amount per service, averaged across 13,321 services

Providers submitted

$416.12

Asking price, not received

Medicare allowed

$122.96

The fee schedule figure

Medicare paid

$92.94

Balance is patient coinsurance

Providers submitted an average of $416.12 for this code and Medicare allowed $122.96 — 3.4× 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 $92.94 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $282.05
Hospital / facility: $63.21

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. 3,637 services were billed in an office setting and 9,684 in a facility.

Services: 13,321
Beneficiaries: 13,064
Providers billing it: 297
Total allowed: $1,637,950

What Medicare pays for CPT 78451

Across 13,321 services billed by 297 providers to 13,064 beneficiaries, Medicare allowed an average of $122.96 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 78451

Specialty	Services	Beneficiaries	Avg allowed	Providers
Cardiology	7,563	7,329	$156.42	168
Diagnostic Radiology	2,936	2,928	$68.03	66
Nuclear Medicine	1,098	1,097	$66.39	27
Internal Medicine	964	951	$95.75	16
Interventional Cardiology	544	543	$140.93	13
Advanced Heart Failure and Transplant Cardiology	167	167	$61.33	4
Radiation Oncology	25	25	$65.23	1
Clinical Cardiac Electrophysiology	13	13	$63.10	1
Vascular Surgery	11	11	$62.65	1

78451 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	2,719	$179.75	$123.31	41
Alabama	1,674	$108.59	$107.68	32
Massachusetts	1,640	$65.22	$44.87	25
Texas	1,524	$220.70	$176.34	31
Maryland	921	$107.75	$78.31	13
New York	736	$94.17	$64.43	22
Virginia	434	$83.58	$61.84	7
Michigan	335	$88.01	$65.61	5
Missouri	301	$60.58	$44.09	7
Florida	287	$121.49	$94.56	9
Ohio	242	$86.21	$65.71	6
Illinois	225	$194.40	$150.63	10
Colorado	199	$64.75	$47.24	8
Indiana	191	$60.10	$44.30	7
New Hampshire	178	$62.11	$47.25	8
Iowa	174	$59.15	$45.42	5
Georgia	147	$62.19	$47.61	5
Tennessee	138	$94.12	$75.50	7
Kansas	129	$116.69	$97.07	4
Wisconsin	124	$58.31	$48.45	3
Arkansas	101	$60.86	$48.54	2
Oregon	101	$129.00	$88.28	3
Montana	93	$61.80	$48.68	5
Pennsylvania	91	$62.65	$46.85	4
West Virginia	86	$60.34	$46.73	3
Arizona	71	$61.60	$46.57	4
Connecticut	64	$64.68	$43.78	5
South Dakota	62	$60.73	$47.13	2
Oklahoma	61	$60.26	$48.67	2
Wyoming	60	$61.40	$45.15	1
District of Columbia	45	$67.32	$49.24	2
New Jersey	37	$66.02	$48.27	2
Utah	31	$289.88	$234.79	1
Nevada	24	$308.50	$202.59	1
South Carolina	23	$61.54	$49.15	1
North Carolina	16	$61.97	$46.15	1
Mississippi	14	$59.49	$49.21	1
Kentucky	12	$63.20	$43.67	1
Washington	11	$62.31	$49.18	1

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
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
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.