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CPT 78472: Nuclear imaging of heart pumping function, labeling red blood cells and measuring blood volume ejected over multiple cycles - Prior Authorization and Price

CPT code 78472 is Nuclear imaging of heart pumping function, labeling red blood cells and measuring blood volume ejected over multiple cycles. See what Aetna, Anthem BCBS, Cigna, UnitedHealthcare look for before approving it, the conditions their guidelines cover, and what it typically costs.

CPT 78472

Nuclear imaging of heart pumping function, labeling red blood cells and measuring blood volume ejected over multiple cycles.

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 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Cardiac Imaging Guidelines effective Feb 3, 2026	5 that name this code
Anthem BCBS	Carelon	Imaging of the heart effective Nov 15, 2025	5 that name this code
Cigna	eviCore	Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 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 Pediatric Cardiac Imaging Guidelines 1.0.2026, effective Feb 3, 2026	5 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	5 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 heart pumping function, labeling red blood cells and measuring blood volume ejected over multiple cycles. Each has its own criteria for when the study is considered appropriate.

Hematopoietic Stem Cell Transplantation Aetna · Cigna · UnitedHealthcare
Congenital heart disease Anthem BCBS
Coronary artery disease (applies to patients with established CAD) Anthem BCBS
Evaluation of left ventricular function Anthem BCBS
Evaluation of right ventricular function Anthem BCBS
Valvular heart disease Anthem BCBS

Typical price

Commercial insurance, median

$863

Middle half of rates: $519 to $1,476

Medicare, hospital outpatient

$408

Facility payment

Medicare, physician fee schedule

$208

National, non-facility

Commercial figures come from negotiated rates published by 960 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 pumping function, labeling red blood cells and measuring blood volume ejected over multiple cycles change.

CPT 78472: Nuclear imaging of heart pumping function, labeling red blood cells and measuring blood volume ejected over multiple cycles - 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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