How much does Medicare pay for CPT 78580?

Medicare allowed an average of $34.16 per service and paid $26.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $196.12, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78580?

Nuclear medicine study of lung circulation. It was billed 16,076 times to 15,884 Medicare beneficiaries by 685 providers in 2024.

Does 78580 pay differently in an office than a hospital?

Yes. The allowed amount averaged $217.31 in an office setting and $33.85 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 78580 most?

Diagnostic Radiology, with 13,410 services from 595 clinicians. Next are Nuclear Medicine, Interventional Radiology, Cardiology.

CPT 78580

Nuclear medicine study of lung circulation

$34.16Medicare-allowed amount per service, averaged across 16,076 services

Providers submitted

$196.12

Asking price, not received

Medicare allowed

$34.16

The fee schedule figure

Medicare paid

$26.33

Balance is patient coinsurance

Providers submitted an average of $196.12 for this code and Medicare allowed $34.16 — 5.7× 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 $26.33 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $217.31
Hospital / facility: $33.85

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. 27 services were billed in an office setting and 16,049 in a facility.

Services: 16,076
Beneficiaries: 15,884
Providers billing it: 685
Total allowed: $549,156

What Medicare pays for CPT 78580

Across 16,076 services billed by 685 providers to 15,884 beneficiaries, Medicare allowed an average of $34.16 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 78580

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	13,410	13,258	$34.18	595
Nuclear Medicine	2,235	2,200	$34.02	72
Interventional Radiology	404	399	$34.20	17
Cardiology	27	27	$35.01	1

78580 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	1,799	$34.41	$27.13	63
Florida	1,751	$34.11	$25.31	83
Illinois	1,749	$34.47	$25.79	75
California	1,150	$34.88	$25.35	50
Virginia	1,069	$33.28	$26.03	33
Maryland	996	$34.94	$25.85	38
Georgia	855	$33.78	$25.49	39
New Jersey	836	$35.61	$25.64	29
Pennsylvania	819	$33.78	$25.76	32
New York	545	$34.71	$25.97	24
Indiana	438	$32.57	$24.87	23
North Carolina	383	$32.62	$25.63	17
Missouri	381	$32.48	$24.75	14
Ohio	335	$33.64	$25.61	13
Arizona	307	$32.87	$25.63	14
Michigan	283	$34.05	$25.34	14
Alabama	214	$32.09	$25.75	12
Massachusetts	205	$48.58	$35.12	8
Delaware	190	$33.53	$26.55	5
Tennessee	189	$32.15	$25.88	13
Louisiana	157	$32.44	$24.74	10
Nevada	147	$32.99	$26.41	8
Mississippi	136	$31.71	$25.80	5
Arkansas	132	$32.04	$25.27	8
Colorado	132	$32.66	$25.40	8
Connecticut	120	$33.92	$26.17	7
Kentucky	111	$31.95	$25.69	5
Kansas	99	$32.25	$25.66	5
Minnesota	82	$33.30	$26.24	4
Rhode Island	66	$34.37	$25.83	3
Washington	57	$34.77	$24.71	3
Oklahoma	48	$31.91	$24.54	3
South Carolina	42	$32.45	$23.52	2
Utah	42	$32.40	$26.57	2
District of Columbia	37	$36.14	$25.77	2
Iowa	30	$32.43	$26.59	2
Nebraska	29	$32.11	$25.71	2
New Hampshire	24	$33.52	$26.60	1
New Mexico	22	$34.64	$25.07	1
Alaska	20	$34.17	$26.51	1
West Virginia	14	$34.00	$26.56	1
Oregon	12	$38.00	$26.62	1
Hawaii	12	$35.26	$24.29	1
Wisconsin	11	$32.38	$26.58	1

Related codes

78582Nuclear medicine study of lung ventilation and circulation$53.09

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.