How much does Medicare pay for CPT 78454?

Medicare allowed an average of $61.60 per service and paid $46.09 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $366.42, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78454?

Nuclear medicine studies of heart muscle at rest and with stress with single 2d image. It was billed 3,603 times to 3,599 Medicare beneficiaries by 100 providers in 2024.

Which specialty bills 78454 most?

Diagnostic Radiology, with 3,185 services from 91 clinicians. Next are Interventional Radiology, Cardiology, Nuclear Medicine.

CPT 78454

Nuclear medicine studies of heart muscle at rest and with stress with single 2d image

$61.60Medicare-allowed amount per service, averaged across 3,603 services

Providers submitted

$366.42

Asking price, not received

Medicare allowed

$61.60

The fee schedule figure

Medicare paid

$46.09

Balance is patient coinsurance

Providers submitted an average of $366.42 for this code and Medicare allowed $61.60 — 5.9× 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 $46.09 (75%); the rest is the patient’s coinsurance and deductible.

Services: 3,603
Beneficiaries: 3,599
Providers billing it: 100
Total allowed: $221,945

What Medicare pays for CPT 78454

Across 3,603 services billed by 100 providers to 3,599 beneficiaries, Medicare allowed an average of $61.60 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 78454

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	3,185	3,181	$61.24	91
Interventional Radiology	249	249	$65.62	2
Cardiology	121	121	$61.77	6
Nuclear Medicine	48	48	$64.69	1

78454 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	681	$65.75	$44.03	16
South Carolina	421	$59.56	$47.27	2
Virginia	376	$60.36	$48.44	11
Oklahoma	346	$60.78	$44.02	3
Illinois	198	$63.89	$45.75	8
Arizona	182	$60.14	$43.69	8
Pennsylvania	161	$62.77	$47.50	6
Florida	158	$62.68	$45.21	5
Tennessee	134	$55.63	$48.46	3
Minnesota	125	$59.95	$47.42	4
West Virginia	118	$59.49	$42.25	4
Missouri	106	$58.69	$42.78	2
Connecticut	93	$62.59	$48.06	2
Maine	72	$62.92	$48.03	4
Texas	65	$60.24	$46.55	4
Nevada	60	$60.39	$43.68	1
Kentucky	40	$60.01	$43.92	2
New Mexico	38	$57.93	$49.08	1
Georgia	35	$63.57	$42.47	1
New Jersey	31	$64.72	$48.70	2
Utah	31	$62.65	$47.14	2
Louisiana	23	$59.07	$42.39	1
New Hampshire	21	$62.84	$46.33	1
Wyoming	15	$60.45	$42.21	1
Vermont	14	$59.90	$48.69	1
Wisconsin	13	$59.05	$42.45	1
North Carolina	12	$59.41	$48.80	1
Montana	12	$61.20	$48.80	1
Nebraska	11	$58.23	$40.29	1
Indiana	11	$58.87	$48.80	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
78451Nuclear medicine study of heart muscle at rest and$122.96
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.