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CPT 78597: Analyzing the blood flow to the lungs and assessing lung ventilation using nuclear medicine - Prior Authorization and Price

CPT code 78597 is Analyzing the blood flow to the lungs and assessing lung ventilation using nuclear medicine. See what Aetna, Anthem BCBS, Cigna, UnitedHealthcare look for before approving it, the conditions their guidelines cover, and what it typically costs.

CPT 78597

Analyzing the blood flow to the lungs and assessing lung ventilation using nuclear medicine.

Nuclear Medicine
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Payer guidelines that apply

PayerReviewed usingGuidelineSections
Aetna eviCore
Chest Imaging Guidelines 1.0.2026, effective Feb 3, 2026
Pediatric Chest Imaging Guidelines 2.0.2026, effective Sep 1, 2026
 5 that name this code
Anthem BCBS Carelon
Nuclear medicine imaging effective Sep 19, 2026
 8 that name this code
Cigna eviCore
Pediatric Cardiac Imaging Guidelines 1.0.2026, effective Feb 3, 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 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 Analyzing the blood flow to the lungs and assessing lung ventilation using nuclear medicine. Each has its own criteria for when the study is considered appropriate.

  • Congenital heart disease Anthem BCBS
  • Congenital pulmonary airway malformation (Pediatric only) Anthem BCBS
  • Congenital thoracic anomalies Anthem BCBS
  • Lung cancer, small cell and non-small cell Anthem BCBS
  • Malignant pleural mesothelioma Anthem BCBS
  • Perioperative evaluation, including evaluation prior to lung transplant Anthem BCBS
  • Pulmonary embolism Anthem BCBS
  • Pulmonary hypertension Anthem BCBS

Typical price

Commercial insurance, median
$719
Middle half of rates: $428 to $1,195
Medicare, hospital outpatient
$408
Facility payment
Medicare, physician fee schedule
$181
National, non-facility

Commercial figures come from negotiated rates published by 776 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 Analyzing the blood flow to the lungs and assessing lung ventilation using nuclear medicine change.

Frequently asked questions

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