CPT 78812
Updated 5/7/2025
Reviewed by Nathan Liu, MD

Positron emission tomography (PET) scan from skull to thigh

Description

This procedure involves a positron emission tomography (PET) scan that images the body from the skull to the thigh, focusing on areas of high metabolic activity. A radiopharmaceutical tracer is administered to highlight cancerous cells, which exhibit increased uptake compared to normal tissues, aiding in the detection of malignancies.

Medicare Provider Reimbursement (PFS)

Facility Setting

Procedure Price$85.72
Limiting Charge$93.65
Patient Coinsurance (20%)$17.14

RVU Calculation Breakdown

Work RVU
1.93
Practice Expense RVU
0.64
Malpractice RVU
0.08
Total RVU
2.65
1.93 + 0.64 + 0.08 = 2.65
2.65 RVUs×$32.3465 Conversion Factor
$85.72

Non-Facility Setting

Procedure Price$85.72
Limiting Charge$93.65
Patient Coinsurance (20%)$17.14

RVU Calculation Breakdown

Work RVU
1.93
Practice Expense RVU
0.64
Malpractice RVU
0.08
Total RVU
2.65
1.93 + 0.64 + 0.08 = 2.65
2.65 RVUs×$32.3465 Conversion Factor
$85.72

Medicare Patient Copayment

After meeting the annual Medicare deductible ($1676 per benefit period up to 60 days for inpatient stays under Part A and $257 for outpatient care under Part B in 2025), Medicare patients are typically responsible for 20% of the Medicare-approved amount as coinsurance. The amounts shown are estimates and may vary based on the patient's specific coverage and whether they have supplemental insurance.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

$1,458.59

Calculation:

x=$1,458.59

Patient Copayment / Coinsurance

$291.72

Calculation breakdown:

  • Minimum (20% of rate)$291.72
Medicare Ambulatory Surgical Center Reimbursement (ASC)

ASC Payment Rate

$783.26

Calculation:

x=$783.26

Patient Copayment / Coinsurance

$156.65

Standard copayment (20%):$156.65

Top Modifiers

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HCPCS/CPT 26Professional component of diagnostic services(68.2%)
HCPCS/CPT PSSubsequent treatment strategy for PET tumor assessment(42.48%)
HCPCS/CPT PIPET scan initial treatment strategy for tumors(34.71%)
HCPCS/CPT GCServices performed by a resident under the supervision of a teaching physician(8.74%)
HCPCS/CPT TCTechnical component of diagnostic imaging services(4.61%)
HCPCS/CPT MGAdvanced diagnostic imaging order lacks appropriate use criteria(4.61%)
HCPCS/CPT Q1Routine clinical service in an approved clinical research study(4.37%)
HCPCS/CPT KXDocumentation requirements met for DMEPOS items(2.91%)
HCPCS/CPT 77Repeat procedure by another qualified healthcare professional(2.43%)
HCPCS/CPT X5Services rendered only as ordered by another clinician(1.7%)
Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

  • List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
  • I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
  • Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
  • OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
  • ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)