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Describe a service in plain words, or type a CPT/HCPCS code.

PET/CT Scan, Whole Body

CPT 78816

Ordered when a cancer or other process is likely to involve the limbs, scalp, or distal skeleton - melanoma and multiple myeloma are the common reasons.

No national payment amount

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

Contractor-published range

$1,511.88–$1,644.69

Enter your ZIP below for the exact amount. Localis has data on file for 3 out of 119 localities.

How much does Medicare pay for CPT 78816? Copy link

CPT 78816 carries status C (carrier-priced) in the Q3 2023 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 $1,511.88–$1,644.69 across 3 localities; enter a ZIP for the exact local amount.

Source: Physician relative value file (Q3 2023) · effective July 2023 · materially updated Aug 7, 2026 · compact facts

Find the local Medicare amount for 78816 Copy link

Medicare sets this price locally

78816 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 currently hold 3 localities across JN. 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.

Contractor-published source figures, not a national rate. Par = participating-provider amount Non-par = nonparticipating-provider amount C = technical component capped at the OPPS amount # = facility-setting amount
View all 6 published fee rows
Jurisdiction / locality Modifier Note Par Non-par Limiting charge Effective Source
JN · Florida, Area 03 CMS 09102-03 — — $1,602.58 $1,522.45 $1,750.82 Jan 1, 2023 Contractor file
JN · Florida, Area 03 CMS 09102-03 -TC C $1,488.13 $1,413.72 $1,625.78 Jan 1, 2023 Contractor file
JN · Florida, Area 04 CMS 09102-04 — — $1,644.69 $1,562.46 $1,796.83 Jan 1, 2023 Contractor file
JN · Florida, Area 04 CMS 09102-04 -TC C $1,527.10 $1,450.75 $1,668.36 Jan 1, 2023 Contractor file
JN · Florida, Area 99 CMS 09102-99 — — $1,511.88 $1,436.29 $1,651.73 Jan 1, 2023 Contractor file
JN · Florida, Area 99 CMS 09102-99 -TC C $1,400.16 $1,330.15 $1,529.67 Jan 1, 2023 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 78816.

See every current NCCI pair for 78816 →

How often 78816 is billed Copy link

Across Original Medicare in CY2024, 78816 ranked #296 of the 7,879 CPT codes billed to Medicare that year, ranked by patients served or total allowed dollars.

Beneficiaries
85,694
Office + facility patients combined
Services
118,607
Times it was billed
Allowed
$67.6M
Total Medicare allowed dollars
Compare: ↑ #295 more popular · 95816 ↓ #297 less popular · 73221

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 Q3 2023 fee schedule the rates above come from.

Common questions Copy link

Why is there no payment amount for 78816?

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 78816 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
  • 78816 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 patients
What does CPT code 78816 mean?

CPT code 78816: PET/CT Scan, Whole Body. A common example is a patient with a melanoma on the calf, or with myeloma affecting bones throughout the skeleton. The scan is carried down the arms and legs rather than stopping at the thighs, so nothing outside the usual field gets missed.

Computation & policy

How this amount is computed Copy link

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.

Release Q3 2023
Component RVU
Work RVU blank
Practice expense RVU (non-facility) blank
Practice expense RVU (facility) blank
Malpractice RVU blank

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.

Billing policy Copy link

What 78816'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.
History & related

Rate history by release Copy link

National non-facility amount for 78816 across quarterly releases.

Release Status Non-facility Facility
Q3 2026 Jun 30, 2026 – present C — —
Q2 2026 Mar 10, 2026 – Jun 29, 2026 C — —
Q1 2026 Dec 29, 2025 – Mar 9, 2026 C — —

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Source & method

Show sources

This is computed from CMS's Medicare Physician Fee Schedule Q3 2023 release (schedule pfs, effective July 2023). 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.

Physician relative value file (Q3 2023) · rvu23c.zip (PPRRVU23_JUL.csv row 14,600)

Conversion factor $33.8872 read from the same file, row 11, column 25.

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 Q3 2023 figures, even after a newer release lands.

CPT 78816 Medicare Physician Fee Schedule rate (Q3 2023). Localis. https://localishealth.com/cpt/78816/2023/C