PET/CT Scan, Skull Base to Mid-Thigh
CPT 78815
Ordered to stage a newly diagnosed cancer, restage after treatment, or look for recurrence when disease could be anywhere in the trunk.
No national payment amount
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Did Medicare pay separately for CPT 78815 in Q2 2015? Copy link
Not at a published national rate. CPT 78815 carries status C (carrier-priced) in the Q2 2015 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Treat the blank amount as unpriced, not as $0.
Source: Physician relative value file (Q2 2015) · effective April 2015 · materially updated Aug 4, 2026 · compact facts
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 78815.
How often 78815 is billed Copy link
Across Original Medicare in CY2024, 78815 ranked #48 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 2015 fee schedule the rates above come from.
Global period: what 78815'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 78815?
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 78815 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
- 78815 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 78815 mean?
CPT code 78815: PET/CT Scan, Skull Base to Mid-Thigh. A common example is a person newly diagnosed with lymphoma or lung cancer who fasts, gets an injection, waits quietly for about an hour, then slides through a scanner for roughly half an hour. The result tells the oncology team whether the disease has spread beyond where it started - the single biggest driver of the treatment plan.
Billing policy Copy link
What 78815'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 2015 release (schedule pfs, effective April 2015). 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 2015 figures, even after a newer release lands.
CPT 78815 Medicare Physician Fee Schedule rate (Q2 2015). Localis. https://localishealth.com/cpt/78815/2015/B