CPT 78816: FDG PET/CT for Whole-Body or Limited Area Imaging
Medicare pays $114 and commercial payers pay $2029 on average nationally for this procedure.
CPT code 78816 describes a positron emission tomography with concurrently acquired computed tomography (PET/CT) using the radiotracer FDG to create combined functional and anatomic images; the service involves intravenous injection of FDG about one hour before scanning, acquisition of PET photon emission data and CT cross-sectional images, and fusion of PET and CT images to localize areas of increased metabolic activity such as malignancy. Service type: diagnostic PET/CT imaging with FDG radiotracer. Typical site of service: outpatient imaging center or hospital radiology/nuclear medicine department.
For related coverage guidance, see recent payer policy updates: Metabolic Disorders - Cysteamine (Oral) Products for Individual and Family Plans, Vafseo (vadadustat) for anemia in CKD on dialysis, Kerendia (finerenone) — Coverage Criteria.
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National Reimbursement Benchmarks
Nationwide, Medicare’s mean rate of $114 is far below the commercial BUCA aggregate mean of $2,029.10, highlighting a substantial public-versus-commercial gap for CPT 78816. Medicare’s central tendency sits tightly with its interquartile band from $110 to $116, reflecting consistent reimbursement across 47 localities, while BUCA’s median of $1,875.20 and mean near $2,029.10 indicate materially higher commercial reimbursement levels overall.
Examining dispersion via the P75–P25 spread: Blue Cross Blue Shield shows a wide spread of $1,333.30 ($3,248.50 − $1,915.20), UnitedHealth Group is also broad at $1,408.00 ($2,174.10 − $265.30), and BUCA’s spread is $1,362.20 ($2,554.70 − $1,192.50). The tightest interquartile ranges are Medicare at $6 ($116 − $110) and Aetna at $1,151.50 ($1,248.50 − $206.60), indicating relatively less variation for Medicare and comparatively moderate variation for Aetna among payers.