CPT 78473

How much did Medicare pay for CPT 78473 in Q1 2019? Copy link

Medicare paid $299.85 for CPT 78473 in the office (non-facility) setting and $299.85 in a facility under the Q1 2019 Physician Fee Schedule, effective January 2019. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. Across payment localities, both settings' amount is $265.97–$388.50. This is a 1.5% decrease from the previous quarter.

Source: Physician relative value file (Q1 2019) · effective January 2019 · materially updated Aug 4, 2026 · compact facts

Rates by locality Copy link

The amounts above use GPCI 1.000, a national baseline no locality actually bills at. Medicare rescales every code by the local Geographic Practice Cost Indices before paying it, so what 78473 pays depends on where the service is furnished. Tap a state for its localities.

Office (non-facility) Facility

$266–$281 $281–$295 $295–$310 $310–$325 $325–$339 $339–$354

Highest-paying locality

$388.50

San Jose-Sunnyvale-Santa Clara (Santa Clara County), CA

Lowest-paying locality

$265.97

West Virginia, WV

78473 non-facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

San Jose, CA $388.50 San Francisco, CA $381.12 Long Island, NY $355.69 Queens, NY $354.96 Washington, DC $353.02 New York City, NY $348.45 Northern New Jersey, NJ $345.67 Boston, MA $345.40 Los Angeles, CA $344.41 Seattle, WA $336.62 San Diego, CA $327.93 Baltimore, MD $325.16 Sacramento, CA $322.27 Philadelphia, PA $320.27 Riverside, CA $318.18 Suburban Chicago, IL $315.07 Portland, OR $312.83 Miami, FL $311.99 Chicago, IL $311.55 Fort Lauderdale, FL $305.35 Austin, TX $304.14 Houston, TX $303.62 Dallas, TX $303.14 Detroit, MI $299.41 Atlanta, GA $299.40 Fort Worth, TX $295.98 New Orleans, LA $292.45 Kansas City, MO $291.07 St. Louis, MO $290.03

$266–$281 $281–$295 $295–$310 $310–$325 $325–$339 $339–$354

Highest-paying locality

$388.50

San Jose-Sunnyvale-Santa Clara (Santa Clara County), CA

Lowest-paying locality

$265.97

West Virginia, WV

78473 facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

San Jose, CA $388.50 San Francisco, CA $381.12 Long Island, NY $355.69 Queens, NY $354.96 Washington, DC $353.02 New York City, NY $348.45 Northern New Jersey, NJ $345.67 Boston, MA $345.40 Los Angeles, CA $344.41 Seattle, WA $336.62 San Diego, CA $327.93 Baltimore, MD $325.16 Sacramento, CA $322.27 Philadelphia, PA $320.27 Riverside, CA $318.18 Suburban Chicago, IL $315.07 Portland, OR $312.83 Miami, FL $311.99 Chicago, IL $311.55 Fort Lauderdale, FL $305.35 Austin, TX $304.14 Houston, TX $303.62 Dallas, TX $303.14 Detroit, MI $299.41 Atlanta, GA $299.40 Fort Worth, TX $295.98 New Orleans, LA $292.45 Kansas City, MO $291.07 St. Louis, MO $290.03

Look up your exact locality →

Q1 2019 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range — its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.

How this amount is computed Copy link

CPT 78473 has a work RVU of 1.47, a non-facility practice expense RVU of 6.76, a facility practice expense RVU of 6.76 and a malpractice RVU of 0.09 — for total non-facility RVUs of 8.32 and total facility RVUs of 8.32 in the Q1 2019 release.

amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.

What does 78473 cost? Copy link

Four numbers get called the cost of a code. Each answers a different question.

National Q1 2019 figures at GPCI 1.000. Adjust for your locality and sequestration, or see the questions below for each figure in full.

Common questions Copy link

Applicable payment rules Copy link

Only the rules that can matter for 78473, each linking to its detail on this page.

Global period: what 78473's fee already covers Copy link

The global surgery concept does not apply to this code.

A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.

Billing 78473 whole or split (-26 and -TC) Copy link

78473 can be billed as one whole service, or split between the physician's interpretation and report (modifier 26) and the equipment, supplies and clinical staff (modifier TC). Which applies depends on who owns the equipment and who reads the study.

The two components add up to the whole-service amount in the office setting, so nothing is lost by splitting the bill — only the party billing each half changes.

A dash means CMS publishes no amount for that line in this release. Read it as unknown, never as zero. National amounts at GPCI 1.000, before sequestration and before any locality adjustment.

Billing policy Copy link

What 78473's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.

Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link

National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.

These apply standard MPFS percentages — assistant surgeon 16%, co-surgeon 62.5%, bilateral 150% — to the national non-facility amount above, so its source citation covers them too. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 78473.

See every current NCCI pair for 78473 →

Rate history by release Copy link

National non-facility amount for 78473 across quarterly releases. -10.0% decrease since Q2 2014 · high $304.56 in Q1 2018

Contracted rate: % of Medicare Copy link

Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 78473 pays at that rate — $299.85 is 100%.

We want to build this: store your multipliers once, and every code page shows your rate instead of Medicare's. Tell us if you'd use it →

See how to find your contract's actual percentage.

How often 78473 is billed Copy link

Across Original Medicare in CY2024, 78473 ranked #5,861 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2019 fee schedule above.