78491 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for 78491, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 35 of the 41 states list more than one rate for 78491, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 41 states, 2 publish 78491 per unit, and 39 schedules print no unit at all (a flat amount per service).
• Per hour. 78491 is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for 78491, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for 78491 run from $17.07 in Kansas to $1,829.68 in Virginia, a 107.2x gap in the same unit. Half the states pay more than the median of $560.72 and half pay less. The usual reasons for a spread like this in radiology rates:

• Advanced imaging such as CT, MRI and PET is often under separate pricing and prior-authorization policies that vary from state to state.
• Imaging fees are split into a professional component (the reading) and a technical component (the equipment and staff), and states publish one, the other or a global amount.
• Some states pay hospitals for the technical component through an outpatient system and pay only the professional component from the physician schedule.

Timing matters too. 22 states set the current rate for 78491 in 2026 or later, while 10 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

No managed-care plan publishes what it pays for 78491. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.

In 7 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 18 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 16 states is not classified yet.

• Plans negotiate; the published rate applies out of network (18 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Plans must pay at least the published rate (7 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Virginia managed care.

78491 is a CPT radiology code in the radiology line, billed mostly by radiology groups, imaging centers and hospitals. Imaging codes are paid per study and split into a professional component (the reading, modifier 26) and a technical component (the equipment and staff, modifier TC). A global amount covers both.

Contrast agents and radiopharmaceuticals are usually billed separately under their own codes. Imaging is billed per study, with modifier 26 for the professional component and TC for the technical component; a claim without either is paid at the global amount where the state publishes one.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.