PET/CT Scan, Limited Area
CPT 78814
Ordered when metabolic imaging is needed for a defined single region, such as characterizing a lung nodule or evaluating a head and neck lesion.
No national payment amount
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Contractor-published range
$1,523.56–$1,656.73
Enter your ZIP below for the exact amount. Contractor files on record cover 3 of 119 payment localities — a locality we don't hold means our coverage is incomplete, not that Medicare pays $0.
How much does Medicare pay for CPT 78814? Copy link
CPT 78814 carries status C (carrier-priced) in the Q2 2022 release, so there is no single national rate — Medicare contractors publish their own amounts. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Contractor-published amounts on file range $1,523.56–$1,656.73 across 3 localities; enter a ZIP for the exact local amount.
Source: Physician relative value file (Q2 2022) · effective April 2022 · materially updated Aug 7, 2026 · compact facts
Find the local Medicare amount for 78814 Copy link
Medicare sets this price locally
78814 has no single national Physician Fee Schedule amount. Enter the service ZIP to match it to a Medicare locality and the contractor amount we have on file.
Your practical estimate will appear here
We hold files from First_coast across JN, most recently effective Jan 1, 2022. A missing locality means our contractor coverage is incomplete—not that Medicare pays $0.
This is the published amount for this code—not necessarily the entire visit or procedure. A hospital may bill a separate facility charge, and other services, drugs, or supplies can add to the total.
View all 6 published fee rows
| Jurisdiction / locality | Modifier | Note | Par | Non-par | Limiting charge | Effective | Source |
|---|---|---|---|---|---|---|---|
| JN · Florida, Area 03 CMS 09102-03 | — | C | $1,620.28 | $1,539.27 | $1,770.16 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 03 CMS 09102-03 | -TC | C | $1,513.41 | $1,437.74 | $1,653.40 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | C | $1,656.73 | $1,573.89 | $1,809.97 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | -TC | C | $1,546.92 | $1,469.57 | $1,690.01 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | C | $1,523.56 | $1,447.38 | $1,664.49 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | -TC | C | $1,419.56 | $1,348.58 | $1,550.87 | Jan 1, 2022 | Contractor file |
The authenticated MAC fees API returns the same source rows. ZIP5s that span localities are flagged and use only the crosswalk's dominant locality until ZIP+4 overrides are available.
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed the same date of service to check the current NCCI procedure-to-procedure edit between it and 78814.
How often 78814 is billed Copy link
Across Original Medicare in CY2024, 78814 ranked #522 of the 7,879 CPT codes billed to Medicare that year, ranked by patients served or total allowed dollars.
2024 Medicare fee-for-service only, national totals — Medicare Advantage, Medicaid and commercial volume are excluded, 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 Q2 2022 fee schedule the rates above come from.
Global period: what 78814's fee already covers Copy link
The global surgery concept does not apply to this code.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Common questions Copy link
Why is there no payment amount for 78814?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.
Why would a Medicare claim for 78814 be denied or paid less?
Each item below comes from a CMS indicator on this page — not general billing advice.
- Its status indicator is C (carrier-priced) — Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
- 78814 splits into a professional component (modifier 26) and a technical component (modifier TC) — a claim for only one part needs that modifier to price correctly. See billing policy
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Saw this code on your bill? Copy link
For patientsWhat does CPT code 78814 mean?
CPT code 78814: PET/CT Scan, Limited Area. A common example is someone with a spot on the lung found on an earlier CT. Instead of scanning them end to end, the technologist images just the chest after a tracer injection, and the doctor looks at whether that spot is metabolically busy - a clue to whether it is likely benign or something that needs a biopsy.
Billing policy Copy link
What 78814'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.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 0 | No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure. |
| Assistant at surgery | 0 | Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity. |
| Co-surgeons | 0 | Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 0 | No reduction. No payment reduction applies when this procedure is billed with other procedures on the same date — each is treated as unrelated. |
| Professional/technical split | 1 | Splits into professional and technical. This procedure splits into a professional component (modifier 26) and a technical component (modifier TC), each separately payable. |
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q2 2022 release (schedule pfs, effective April 2022). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Commercial and cash-pay figures anywhere on this page are arithmetic on the Medicare amount, using commonly cited reimbursement ranges. They're illustrative, and no nationwide claims database stands behind them. Our methodology covers all of this in depth — sourcing, parsing, versioning, and how claims are cross-checked before they ship.
Description written from primary sources: CMS Medicare Physician Fee Schedule Relative Value Files. Not derived from AMA CPT descriptor text.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q2 2022 figures, even after a newer release lands.
CPT 78814 Medicare Physician Fee Schedule rate (Q2 2022). Localis. https://localishealth.com/cpt/78814/2022/B