CPT 78816
Updated 5/7/2025
Reviewed by Nathan Liu, MD

Positron emission tomography (PET) scan with computed tomography (CT), full body

Description

This procedure involves the administration of a radiopharmaceutical tracer, allowing for the detection of cancerous cells through emitted photons. The combination of PET and CT imaging provides detailed three-dimensional images, enhancing the accuracy of tumor size and location assessment across the entire body.

Medicare Provider Reimbursement (PFS)

Facility Setting

Procedure Price$109.65
Limiting Charge$119.80
Patient Coinsurance (20%)$21.93

RVU Calculation Breakdown

Work RVU
2.50
Practice Expense RVU
0.79
Malpractice RVU
0.10
Total RVU
3.39
2.50 + 0.79 + 0.10 = 3.39
3.39 RVUs×$32.3465 Conversion Factor
$109.65

Non-Facility Setting

Procedure Price$109.65
Limiting Charge$119.80
Patient Coinsurance (20%)$21.93

RVU Calculation Breakdown

Work RVU
2.50
Practice Expense RVU
0.79
Malpractice RVU
0.10
Total RVU
3.39
2.50 + 0.79 + 0.10 = 3.39
3.39 RVUs×$32.3465 Conversion Factor
$109.65

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 2026), 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

Graph View

List View

HCPCS/CPT 26Professional component of diagnostic services(52.7%)
HCPCS/CPT PSSubsequent treatment strategy for PET tumor assessment(40.22%)
HCPCS/CPT PIPET scan initial treatment strategy for tumors(35.42%)
HCPCS/CPT TCTechnical component of diagnostic imaging services(14.1%)
HCPCS/CPT MGAdvanced diagnostic imaging order lacks appropriate use criteria(7.44%)
HCPCS/CPT GCServices performed by a resident under the supervision of a teaching physician(4.77%)
HCPCS/CPT MEAdvanced diagnostic imaging order adheres to appropriate use criteria(4.65%)
HCPCS/CPT KXDocumentation requirements met for DMEPOS items(3.6%)
HCPCS/CPT GAWaiver of liability statement issued per payer policy(3.22%)
HCPCS/CPT MHClinical decision support mechanism consultation not documented(2.48%)
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)