How much does Medicare pay for CPT 78816?

Medicare allowed an average of $568.60 per service and paid $449.77 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2122.13, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 78816?

Nuclear medicine study whole body with ct scan. It was billed 96,985 times to 87,874 Medicare beneficiaries by 2,229 providers in 2024.

Does 78816 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1066.17 in an office setting and $111.41 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 78816 most?

Diagnostic Radiology, with 61,420 services from 1,577 clinicians. Next are Nuclear Medicine, Independent Diagnostic Testing Facility (IDTF), Hematology-Oncology.

CPT 78816

Nuclear medicine study whole body with ct scan

$568.60Medicare-allowed amount per service, averaged across 96,985 services

Providers submitted

$2122.13

Asking price, not received

Medicare allowed

$568.60

The fee schedule figure

Medicare paid

$449.77

Balance is patient coinsurance

Providers submitted an average of $2122.13 for this code and Medicare allowed $568.60 — 3.7× 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 $449.77 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1066.17
Hospital / facility: $111.41

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. 46,441 services were billed in an office setting and 50,544 in a facility.

Services: 96,985
Beneficiaries: 87,874
Providers billing it: 2,229
Total allowed: $55,145,671

What Medicare pays for CPT 78816

Across 96,985 services billed by 2,229 providers to 87,874 beneficiaries, Medicare allowed an average of $568.60 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 78816

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	61,420	56,163	$469.39	1,577
Nuclear Medicine	24,094	22,203	$448.41	308
Independent Diagnostic Testing Facility (IDTF)	4,316	3,445	$1526.65	86
Hematology-Oncology	3,281	2,760	$1432.80	144
Radiation Oncology	1,181	1,001	$1235.06	32
Interventional Radiology	1,054	966	$565.87	25
Medical Oncology	985	757	$1417.12	34
Internal Medicine	370	307	$1167.39	10
Undefined Physician type	78	74	$1019.53	1
Family Practice	51	51	$708.57	3
Hematology	47	41	$1853.33	3
Emergency Medicine	29	28	$607.46	2
Gynecological Oncology	25	25	$1681.10	1
Pediatric Medicine	22	22	$1348.62	1
Surgical Oncology	20	19	$1407.06	1

78816 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	11,269	$828.88	$647.74	233
Florida	9,331	$799.79	$628.62	135
Texas	8,940	$404.00	$316.60	166
New York	8,320	$759.04	$589.48	159
Massachusetts	4,244	$630.79	$496.06	67
Pennsylvania	3,625	$493.37	$386.08	91
North Carolina	3,525	$259.69	$201.71	71
Virginia	3,259	$606.65	$493.20	71
Maryland	3,090	$984.28	$779.97	63
Illinois	2,628	$346.40	$268.79	87
Arizona	2,602	$774.32	$614.15	76
Arkansas	2,380	$578.04	$459.64	47
Minnesota	2,226	$332.15	$255.49	62
Washington	2,061	$505.69	$394.39	50
New Jersey	2,019	$833.23	$654.01	60
Ohio	1,948	$180.28	$138.30	42
Colorado	1,886	$597.18	$473.54	43
Michigan	1,754	$205.25	$158.98	47
Missouri	1,746	$140.08	$108.28	46
Georgia	1,709	$188.19	$143.71	46
Tennessee	1,529	$442.11	$349.22	46
South Carolina	1,479	$324.29	$248.85	46
Wisconsin	1,368	$379.81	$299.71	45
Indiana	1,272	$286.58	$224.22	39
Oklahoma	1,174	$371.69	$290.64	39
Kentucky	1,067	$196.15	$154.55	34
Kansas	1,060	$379.62	$299.36	24
Oregon	965	$431.17	$345.34	23
Iowa	909	$346.22	$274.22	18
Nebraska	716	$544.86	$434.99	24
Mississippi	587	$216.33	$169.12	19
Alabama	544	$1043.57	$827.98	20
Connecticut	539	$326.90	$248.07	19
Nevada	495	$1116.28	$890.23	25
Louisiana	469	$530.77	$428.17	17
Maine	463	$315.69	$243.54	13
New Hampshire	361	$228.87	$174.91	9
Idaho	346	$572.30	$454.05	12
Utah	303	$106.36	$83.46	9
Rhode Island	284	$284.89	$222.62	9
Delaware	264	$324.37	$252.42	9
Alaska	258	$1280.50	$1018.23	5
South Dakota	255	$312.78	$237.12	7
Vermont	248	$238.99	$181.62	6
New Mexico	222	$921.92	$720.48	9
West Virginia	213	$109.62	$80.23	6
Puerto Rico	207	$1090.40	$858.54	7
Hawaii	196	$1034.90	$825.67	3
North Dakota	191	$286.11	$213.08	9
Montana	159	$109.46	$81.82	7
District of Columbia	142	$141.98	$101.35	5
Wyoming	96	$864.17	$641.06	2
XX	27	$1396.13	$1112.36	1
AP	15	$109.98	$80.45	1

Related codes

78815Nuclear medicine study from skull base to mid-thigh$611.91
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
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.