How much does Medicare pay for CPT 78813?

Medicare allowed an average of $400.76 per service and paid $318.07 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1530.26, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78813?

Nuclear medicine study whole body. It was billed 1,696 times to 1,490 Medicare beneficiaries by 46 providers in 2024.

Does 78813 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1156.38 in an office setting and $86.65 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 78813 most?

Diagnostic Radiology, with 1,183 services from 33 clinicians. Next are Nuclear Medicine, Interventional Radiology, Independent Diagnostic Testing Facility (IDTF).

CPT 78813

Nuclear medicine study whole body

$400.76Medicare-allowed amount per service, averaged across 1,696 services

Providers submitted

$1530.26

Asking price, not received

Medicare allowed

$400.76

The fee schedule figure

Medicare paid

$318.07

Balance is patient coinsurance

Providers submitted an average of $1530.26 for this code and Medicare allowed $400.76 — 3.8× 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 $318.07 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1156.38
Hospital / facility: $86.65

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. 498 services were billed in an office setting and 1,198 in a facility.

Services: 1,696
Beneficiaries: 1,490
Providers billing it: 46
Total allowed: $679,689

What Medicare pays for CPT 78813

Across 1,696 services billed by 46 providers to 1,490 beneficiaries, Medicare allowed an average of $400.76 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 78813

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	1,183	1,009	$386.74	33
Nuclear Medicine	334	317	$247.15	10
Interventional Radiology	118	105	$426.62	1
Independent Diagnostic Testing Facility (IDTF)	49	47	$1360.40	1
Radiation Oncology	12	12	$1885.14	1

78813 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
Minnesota	572	$232.61	$180.86	14
Michigan	258	$328.55	$260.34	9
North Carolina	184	$85.29	$66.56	4
Maryland	151	$1699.59	$1354.14	1
Georgia	93	$91.32	$67.09	1
Arkansas	93	$83.49	$68.08	1
California	92	$476.48	$366.89	5
Pennsylvania	88	$401.78	$312.13	2
Illinois	58	$429.59	$341.34	3
Wisconsin	40	$1508.64	$1202.00	2
Missouri	19	$84.22	$68.11	1
Washington	16	$99.14	$67.98	1
New York	16	$265.20	$191.86	1
Florida	16	$87.11	$64.35	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
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.