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CPT 78468: Nuclear imaging of heart muscle after a heart attack, measuring blood volume ejected with each heartbeat - Prior Authorization and Price

CPT code 78468 is Nuclear imaging of heart muscle after a heart attack, measuring blood volume ejected with each heartbeat. See what Aetna, Anthem BCBS, Cigna, UnitedHealthcare look for before approving it, the conditions their guidelines cover, and what it typically costs.

CPT 78468

Nuclear imaging of heart muscle after a heart attack, measuring blood volume ejected with each heartbeat.

Nuclear Medicine

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Cardiac Imaging Guidelines effective Feb 3, 2026	2 that name this code
Anthem BCBS	Carelon	Imaging of the heart effective Nov 15, 2025	1 that name this code
Cigna	eviCore	Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Cardiac Imaging Guidelines 1.0.2026, effective Feb 3, 2026	2 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.

Typical price

Commercial insurance, median

$576

Middle half of rates: $471 to $778

Medicare, hospital outpatient

$555

Facility payment

Medicare, physician fee schedule

$184

National, non-facility

Commercial figures come from negotiated rates published by 437 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 heart muscle after a heart attack, measuring blood volume ejected with each heartbeat change.

CPT 78468: Nuclear imaging of heart muscle after a heart attack, measuring blood volume ejected with each heartbeat - Prior Authorization and Price

Payer guidelines that apply

Typical price

Get notified when the rules for this study change

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