Which payers have published criteria for Nuclear imaging of the lymphatic system (CPT 78195)?

The imaging guidelines used by Aetna, Anthem BCBS, Cigna, UnitedHealthcare include criteria that apply to this study. Whether a specific patient's plan requires prior authorization depends on the plan, so confirm on the payer's portal or by phone before scheduling.

Who reviews prior authorization requests for Nuclear imaging of the lymphatic system (CPT 78195)?

Most commercial payers hand imaging reviews to a radiology benefit manager. For the payers tracked here, requests are reviewed using guidelines from eviCore, Carelon, CMS, UnitedHealthcare / eviCore. The request is submitted through that organization's portal rather than the health plan's general line.

What should be in the clinical notes before requesting Nuclear imaging of the lymphatic system (CPT 78195)?

Reviewers look for a recent office visit that documents the symptoms and how long they have lasted, exam findings, results of any earlier imaging, treatments already tried and how the patient responded, and the specific question the study is expected to answer. The diagnosis code on the request should match what the notes describe.

How much does Nuclear imaging of the lymphatic system (CPT 78195) cost?

Across 914 hospitals that publish their negotiated rates, the median commercial insurance rate is $958, with the middle half of rates between $599 and $1,600. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if Nuclear imaging of the lymphatic system (CPT 78195) is denied?

Read the denial letter for the stated reason, then request a peer-to-peer conversation between the ordering clinician and the reviewing physician, which often resolves missing-information denials. If that fails, file a written appeal that answers the stated reason directly and attach the supporting notes. The denial letter lists the deadline and where to send the appeal.

CPT 78195: Nuclear imaging of the lymphatic system - Prior Authorization and Price

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CPT 78195

Nuclear imaging of the lymphatic system.

Nuclear Medicine

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Peripheral Vascular Disease (PVD) Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Pelvis Imaging Guidelines 1.0.2026, effective Feb 3, 2026	10 that name this code
Anthem BCBS	Carelon	Nuclear medicine imaging effective Sep 19, 2026	8 that name this code
Cigna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Peripheral Vascular Disease (PVD) Imaging Guidelines 2.0.2026, effective Sep 1, 2026	12 that name this code
Medicare	CMS	—	None found
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare	UnitedHealthcare / eviCore	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	10 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss Nuclear imaging of the lymphatic system. Each has its own criteria for when the study is considered appropriate.

Breast Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Melanomas and Other Skin Cancers Aetna · Cigna · UnitedHealthcare
Uterine Cancer Aetna · Anthem BCBS · Cigna · UnitedHealthcare
Anal Cancer & Cancers of the External Genitalia Aetna · Cigna · UnitedHealthcare
Squamous Cell Carcinomas of the Head and Neck Aetna · Cigna · UnitedHealthcare
Acute Limb Swelling Aetna · Cigna · UnitedHealthcare
Cervical cancer Anthem BCBS
Head and neck cancer Anthem BCBS
Lymphedema Anthem BCBS
Melanoma Anthem BCBS
Merkel cell carcinoma Anthem BCBS
Penile, vaginal, and vulvar cancers Anthem BCBS

Typical price

Commercial insurance, median

$958

Middle half of rates: $599 to $1,600

Medicare, hospital outpatient

$555

Facility payment

Medicare, physician fee schedule

$313

National, non-facility

Commercial figures come from negotiated rates published by 914 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for Nuclear imaging of the lymphatic system change.

CPT 78195: Nuclear imaging of the lymphatic system - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

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