How much does Medicare pay for CPT 78811?

Medicare allowed an average of $856.12 per service and paid $682.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5451.94, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78811?

Nuclear medicine study limited area. It was billed 1,085 times to 835 Medicare beneficiaries by 33 providers in 2024.

Does 78811 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1016.55 in an office setting and $75.65 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 78811 most?

Diagnostic Radiology, with 775 services from 19 clinicians. Next are Nuclear Medicine, Pulmonary Disease, Cardiology.

CPT 78811

Nuclear medicine study limited area

$856.12Medicare-allowed amount per service, averaged across 1,085 services

Providers submitted

$5451.94

Asking price, not received

Medicare allowed

$856.12

The fee schedule figure

Medicare paid

$682.36

Balance is patient coinsurance

Providers submitted an average of $5451.94 for this code and Medicare allowed $856.12 — 6.4× 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 $682.36 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1016.55
Hospital / facility: $75.65

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. 900 services were billed in an office setting and 185 in a facility.

Services: 1,085
Beneficiaries: 835
Providers billing it: 33
Total allowed: $928,890

What Medicare pays for CPT 78811

Across 1,085 services billed by 33 providers to 835 beneficiaries, Medicare allowed an average of $856.12 per service. That is 1.3 services per beneficiary, so this is a code patients typically receive more than once. 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 78811

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	775	544	$933.70	19
Nuclear Medicine	175	174	$766.14	10
Pulmonary Disease	94	76	$73.69	3
Cardiology	41	41	$1567.65	1

78811 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
New York	635	$1010.75	$784.85	10
California	117	$693.54	$582.78	6
Florida	107	$733.16	$580.89	6
New Jersey	94	$73.69	$51.58	3
Alabama	36	$1273.04	$975.89	2
Maryland	21	$1515.70	$1207.63	1
Wisconsin	18	$1360.05	$1083.62	1
Oregon	17	$77.49	$50.19	1
Georgia	16	$70.90	$52.72	1
Arkansas	13	$76.97	$52.72	1
Illinois	11	$1359.26	$1082.99	1

Related codes

78815Nuclear medicine study from skull base to mid-thigh$611.91
78816Nuclear medicine study whole body$568.60
78803Nuclear medicine study$136.74
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

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.