CPT 78815: PET/CT Tumor Imaging with Anatomical Localization
Medicare pays $112 and commercial payers pay $2026 on average nationally for this procedure.
CPT code 78815 describes a combined PET/CT tumor imaging study in which positron emission tomography and computed tomography data are fused to provide both metabolic information and precise anatomical localization; service type: diagnostic PET with concurrently acquired CT for attenuation correction and anatomical localization (combined PET/CT); typical site of service: outpatient imaging centers or hospital radiology departments performing oncologic staging and tumor assessment.
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National Reimbursement Benchmarks
Medicare’s mean allowed rate of $112.3 is far below the commercial average represented by BUCA’s mean of $2,026.20, underscoring a wide gulf between government reimbursement and typical commercial contracts for CPT 78815. This gap reflects fundamentally different pricing benchmarks: Medicare’s tightly clustered local rates (p25 $108, p50 $112, p75 $114) contrast with BUCA’s substantially higher central tendency (p50 $1,824.30) and broader spread across commercial payers.
Measuring dispersion as P75 minus P25, Blue Cross Blue Shield shows one of the narrowest interquartile spreads at $1,310.30 (p75 $3,252.40 minus p25 $1,942.10), while UnitedHealth Group’s spread is $1,887.10 (p75 $2,150.60 minus p25 $263.90). Cigna’s IQR is $1,241.60, Aetna’s is $1,082.20, and BUCA’s IQR is $1,342.50; Medicare is the tightest with an IQR of $6.00. These differences highlight greater variability among commercial payers compared with Medicare.