How much does Medicare pay for CPT 78472?

Medicare allowed an average of $123.30 per service and paid $92.60 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $479.18, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 78472 pay differently in an office than a hospital?

Yes. The allowed amount averaged $179.95 in an office setting and $44.76 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 78472 most?

Diagnostic Radiology, with 715 services from 36 clinicians. Next are Cardiology, Nuclear Medicine, Interventional Cardiology.

CPT 78472

Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume ejected with every beat over multiple cycles

$123.30Medicare-allowed amount per service, averaged across 2,105 services

Providers submitted

$479.18

Asking price, not received

Medicare allowed

$123.30

The fee schedule figure

Medicare paid

$92.60

Balance is patient coinsurance

Providers submitted an average of $479.18 for this code and Medicare allowed $123.30 — 3.9× 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 $92.60 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $179.95
Hospital / facility: $44.76

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. 1,223 services were billed in an office setting and 882 in a facility.

Services: 2,105
Beneficiaries: 1,979
Providers billing it: 103
Total allowed: $259,547

What Medicare pays for CPT 78472

Across 2,105 services billed by 103 providers to 1,979 beneficiaries, Medicare allowed an average of $123.30 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 78472

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	715	644	$93.64	36
Cardiology	626	601	$163.03	33
Nuclear Medicine	390	373	$69.88	18
Interventional Cardiology	149	144	$185.00	8
Internal Medicine	145	145	$190.92	3
Hematology-Oncology	26	23	$148.27	2
Interventional Radiology	24	23	$44.99	1
Medical Oncology	17	13	$150.37	1
Advanced Heart Failure and Transplant Cardiology	13	13	$42.55	1

78472 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	392	$126.12	$98.37	23
California	335	$189.38	$120.15	10
Texas	216	$58.89	$46.14	11
Alabama	207	$180.04	$156.90	8
Missouri	109	$43.41	$34.49	5
Oklahoma	106	$84.79	$69.53	4
Ohio	101	$44.22	$34.05	4
Delaware	93	$155.11	$120.62	6
Georgia	86	$96.28	$84.07	6
Washington	61	$48.26	$32.78	3
Illinois	58	$176.63	$134.30	4
Maryland	51	$230.69	$161.26	2
Iowa	46	$41.85	$31.67	3
Pennsylvania	46	$189.11	$158.06	2
Arkansas	33	$177.23	$156.63	1
Arizona	29	$197.60	$149.25	2
New Jersey	25	$47.52	$30.98	2
Indiana	21	$42.54	$35.09	1
Louisiana	19	$173.50	$148.62	1
New Mexico	16	$45.73	$35.16	1
Michigan	16	$44.88	$32.85	1
Minnesota	14	$45.78	$35.23	1
Oregon	14	$44.44	$32.55	1
New York	11	$49.51	$35.13	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
78454Nuclear medicine studies of heart muscle at rest and$61.60

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.