Which payers have published criteria for PET brain, metabolic evaluation (CPT 78608)?

The imaging guidelines used by Aetna, Anthem BCBS, Cigna, Medicare, UnitedHealthcare include criteria that apply to this study. Whether a specific patient's plan requires prior authorization depends on the plan, so confirm on the payer's portal or by phone before scheduling.

Who reviews prior authorization requests for PET brain, metabolic evaluation (CPT 78608)?

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 PET brain, metabolic evaluation (CPT 78608)?

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.

How much does PET brain, metabolic evaluation (CPT 78608) cost?

Across 684 hospitals that publish their negotiated rates, the median commercial insurance rate is $3,224, with the middle half of rates between $2,056 and $5,169. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if PET brain, metabolic evaluation (CPT 78608) is denied?

Read the denial letter for the stated reason, then request a peer-to-peer conversation between the ordering clinician and the reviewing physician, which often resolves missing-information denials. If that fails, file a written appeal that answers the stated reason directly and attach the supporting notes. The denial letter lists the deadline and where to send the appeal.

CPT 78608: PET brain, metabolic evaluation - Prior Authorization and Price

Home › CPT Codes › PET brain, metabolic evaluation

CPT 78608

Nuclear imaging study of the brain that includes metabolic evaluation.

PET Head & Neck

Build a submission checklist for this study

Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Head 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 Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026	19 that name this code
Anthem BCBS	Carelon	Oncologic imaging effective Apr 4, 2026 Imaging of the brain effective Sep 19, 2026	3 that name this code
Cigna	eviCore	Head 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 Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026	18 that name this code
Medicare	CMS	NCD 220.6.17: Positron Emission Tomography (FDG) for Oncologic Conditions effective Aug 17, 2026 NCD 220.6.19: Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer effective Feb 27, 2024 NCD 220.6.9: FDG PET for Refractory Seizures effective Oct 4, 2022 NCD 220.6.13: FDG PET for Dementia and Neurodegenerative Diseases effective Aug 16, 2023	5 that name this code
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	19 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 PET brain, metabolic evaluation. Each has its own criteria for when the study is considered appropriate.

Cerebral Vasculitis Aetna · Cigna · UnitedHealthcare
CNS and Head Infection/Neuro-COVID-19 Aetna · Cigna · UnitedHealthcare
Epilepsy/Seizures Aetna · Cigna · UnitedHealthcare
Mild Cognitive Impairment (MCI) and Dementia Aetna · Cigna · UnitedHealthcare
Other Imaging Studies Aetna · Cigna · UnitedHealthcare
Movement Disorders Aetna · UnitedHealthcare
CNS Tumors Aetna · Cigna · UnitedHealthcare
Primary Central Nervous System Tumors Aetna · Cigna · UnitedHealthcare
Specialized Imaging Techniques Aetna · Cigna · UnitedHealthcare
Epilepsy and Other Seizure Disorders Aetna · Cigna · UnitedHealthcare
Metastatic Cancer, Carcinoma of Unknown Primary Site, and Other Types of Cancer Aetna · Cigna · UnitedHealthcare
Pediatric Demyelinating Diseases Aetna · Cigna · UnitedHealthcare
Brain and Spinal Cord Malignancy Anthem BCBS
FDG PET for Dementia and Neurodegenerative Diseases Medicare
FDG PET for Refractory Seizures Medicare
Histiocytic Neoplasms Anthem BCBS
Neurocognitive disorders (Adult only) Anthem BCBS
Positron Emission Tomography (FDG) for Oncologic Conditions Medicare
Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer Medicare
Positron Emission Tomography (PET) Scan for Inflammation and Infection Medicare

Typical price

Commercial insurance, median

$3,224

Middle half of rates: $2,056 to $5,169

Medicare, hospital outpatient

$1,461

Facility payment

Medicare, physician fee schedule

$67

National, non-facility

Commercial figures come from negotiated rates published by 684 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 PET brain, metabolic evaluation change.

CPT 78608: PET brain, metabolic evaluation - 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

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET

CPT 78608: PET brain, metabolic evaluation - 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

Related studies

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET