How much does Medicare pay for CPT 78803?

Medicare allowed an average of $136.74 per service and paid $106.84 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $593.28, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78803?

Nuclear medicine study, spect imaging, 1 area or single acquisition, single day imaging. It was billed 30,861 times to 30,154 Medicare beneficiaries by 945 providers in 2024.

Does 78803 pay differently in an office than a hospital?

Yes. The allowed amount averaged $285.86 in an office setting and $49.64 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 78803 most?

Diagnostic Radiology, with 18,091 services from 546 clinicians. Next are Nuclear Medicine, Cardiology, Independent Diagnostic Testing Facility (IDTF).

CPT 78803

Nuclear medicine study, spect imaging, 1 area or single acquisition, single day imaging

$136.74Medicare-allowed amount per service, averaged across 30,861 services

Providers submitted

$593.28

Asking price, not received

Medicare allowed

$136.74

The fee schedule figure

Medicare paid

$106.84

Balance is patient coinsurance

Providers submitted an average of $593.28 for this code and Medicare allowed $136.74 — 4.3× 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 $106.84 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $285.86
Hospital / facility: $49.64

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. 11,379 services were billed in an office setting and 19,482 in a facility.

Services: 30,861
Beneficiaries: 30,154
Providers billing it: 945
Total allowed: $4,219,933

What Medicare pays for CPT 78803

Across 30,861 services billed by 945 providers to 30,154 beneficiaries, Medicare allowed an average of $136.74 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 78803

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	18,091	17,591	$133.18	546
Nuclear Medicine	5,201	5,116	$126.21	154
Cardiology	5,180	5,162	$130.66	177
Independent Diagnostic Testing Facility (IDTF)	772	695	$287.43	12
Interventional Radiology	438	414	$158.52	13
Internal Medicine	260	259	$129.75	12
Interventional Cardiology	248	247	$296.05	12
Advanced Heart Failure and Transplant Cardiology	245	244	$65.21	10
Neurology	162	162	$265.94	2
Family Practice	105	105	$87.98	2
Radiation Oncology	66	66	$46.38	2
Clinical Cardiac Electrophysiology	65	65	$48.36	1
Nurse Practitioner	15	15	$40.68	1
Endocrinology	13	13	$289.39	1

78803 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	3,474	$216.41	$145.77	108
Texas	2,903	$151.60	$120.07	70
Florida	2,826	$244.31	$195.48	72
New York	2,077	$107.66	$73.68	58
New Jersey	1,549	$99.73	$70.38	50
Arizona	1,518	$188.81	$152.90	20
Pennsylvania	1,468	$83.85	$64.27	63
Maryland	1,304	$153.08	$111.39	28
Illinois	1,242	$129.01	$99.78	38
Massachusetts	1,044	$67.81	$48.63	40
Washington	923	$143.78	$106.70	28
Virginia	856	$133.06	$98.02	29
Georgia	843	$124.61	$104.05	28
South Carolina	708	$52.40	$41.60	17
Ohio	621	$141.91	$111.08	20
Tennessee	603	$46.25	$36.84	19
Connecticut	520	$66.36	$47.57	16
North Carolina	516	$66.25	$50.66	17
Michigan	392	$48.82	$36.23	14
Indiana	385	$90.90	$73.26	18
Mississippi	354	$100.25	$88.35	8
Minnesota	352	$103.74	$79.03	19
Kansas	327	$68.91	$55.28	7
Louisiana	321	$200.11	$175.20	8
Oklahoma	319	$46.52	$37.04	12
Nevada	303	$173.37	$149.11	8
Missouri	301	$85.83	$68.00	15
Colorado	284	$50.78	$36.77	7
Alabama	249	$76.54	$63.09	13
Arkansas	248	$46.01	$37.94	6
Iowa	237	$127.52	$109.50	10
Wisconsin	229	$195.52	$127.03	7
New Hampshire	215	$48.08	$35.69	7
Kentucky	185	$48.60	$36.10	10
Delaware	163	$71.48	$56.01	4
District of Columbia	141	$52.05	$37.47	6
Oregon	115	$49.36	$38.22	8
Rhode Island	113	$50.08	$35.96	4
West Virginia	107	$48.35	$38.31	6
North Dakota	102	$47.70	$36.17	5
Puerto Rico	86	$323.49	$245.75	3
Nebraska	64	$172.00	$147.45	4
South Dakota	63	$46.28	$38.07	4
Montana	47	$47.77	$38.36	3
Idaho	44	$226.70	$193.61	2
Hawaii	42	$47.47	$36.18	2
Maine	29	$50.43	$37.08	1
New Mexico	21	$49.04	$37.03	1
Utah	16	$46.52	$38.35	1
Alaska	12	$67.90	$38.63	1

Related codes

78815Nuclear medicine study from skull base to mid-thigh$611.91
78816Nuclear medicine study whole body$568.60
78814Nuclear medicine study limited area$1034.63
78830Nuclear medicine study$126.84
78812Nuclear medicine study from skull base to mid-thigh$282.09
78832Nuclear medicine study$338.43
78835Quantification of radioactive materials$82.32
78800Nuclear medicine study$79.10
78802Nuclear medicine study$114.52
78813Nuclear medicine study whole body$400.76
78811Nuclear medicine study limited area$856.12

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.