Who reviews prior authorization requests for Nuclear imaging study of a limited area of bone or joint (CPT 78300)?

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 study of a limited area of bone or joint (CPT 78300)?

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 78300: Nuclear imaging study of a limited area of bone or joint - Prior Authorization and Price

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CPT 78300

Nuclear imaging study of a limited area of bone or joint.

Nuclear Medicine

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Pediatric Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Spine Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	18 that name this code
Anthem BCBS	Carelon	Nuclear medicine imaging effective Sep 19, 2026	11 that name this code
Cigna	eviCore	Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	3 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	18 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 study of a limited area of bone or joint. Each has its own criteria for when the study is considered appropriate.

Avascular necrosis, when MRI cannot be performed or is nondiagnostic Anthem BCBS
Fracture, when MRI cannot be performed or is nondiagnostic Anthem BCBS
Indeterminate bone lesion of the extremity Anthem BCBS
Infection, not otherwise specified Anthem BCBS
Known or suspected bone metastases, not otherwise specified Anthem BCBS
Limping child, age 5 years or younger Anthem BCBS
Osseous tumor Anthem BCBS
Paget’s disease Anthem BCBS
Pelvic fracture, when MRI cannot be performed or is nondiagnostic Anthem BCBS
Perioperative evaluation, not otherwise specified, including delayed hardware failure Anthem BCBS
Skull tumor evaluation Anthem BCBS
Pediatric Back and Neck Pain and Trauma Aetna · UnitedHealthcare
Fracture and Dislocation Aetna · UnitedHealthcare
Infection/Osteomyelitis Aetna · UnitedHealthcare
Suspected Physical Child Abuse Aetna · UnitedHealthcare
Neuroblastoma Aetna · Cigna · UnitedHealthcare
Avascular Necrosis (AVN) / Legg-Calvé-Perthes Disease / Idiopathic Osteonecrosis Aetna · UnitedHealthcare
Inflammatory Musculoskeletal Disease Aetna · UnitedHealthcare
Kyphosis and Scoliosis Aetna · UnitedHealthcare
Limping Child Aetna · UnitedHealthcare
Nuclear Medicine Aetna · UnitedHealthcare

Typical price

Commercial insurance, median

$729

Middle half of rates: $452 to $1,198

Medicare, hospital outpatient

$408

Facility payment

Medicare, physician fee schedule

$200

National, non-facility

Commercial figures come from negotiated rates published by 956 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 study of a limited area of bone or joint change.

CPT 78300: Nuclear imaging study of a limited area of bone or joint - 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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