What should be in the clinical notes before requesting Carrying out a nuclear medicine study to evaluate gastrointestinal blood loss (CPT 78278)?

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.

CPT 78278: Carrying out a nuclear medicine study to evaluate gastrointestinal blood loss - Prior Authorization and Price

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CPT 78278

Carrying out a nuclear medicine study to evaluate gastrointestinal blood loss.

Nuclear Medicine

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026	2 that name this code
Anthem BCBS	Carelon	Nuclear medicine imaging effective Sep 19, 2026	1 that name this code
Cigna	eviCore	Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026	1 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	2 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 Carrying out a nuclear medicine study to evaluate gastrointestinal blood loss. Each has its own criteria for when the study is considered appropriate.

GI Bleeding Aetna · Cigna · UnitedHealthcare
Hematoma/hemorrhage within the abdomen or unexplained hypotension Anthem BCBS

Typical price

Commercial insurance, median

$877

Middle half of rates: $510 to $1,515

Medicare, hospital outpatient

$408

Facility payment

Medicare, physician fee schedule

$307

National, non-facility

Commercial figures come from negotiated rates published by 979 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 Carrying out a nuclear medicine study to evaluate gastrointestinal blood loss change.

CPT 78278: Carrying out a nuclear medicine study to evaluate gastrointestinal blood loss - 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

Frequently asked questions

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