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CPT 78630: Conducting a nuclear medicine study to assess cerebrospinal fluid flow with contrast injected into the lower spine - Prior Authorization and Price

CPT code 78630 is Conducting a nuclear medicine study to assess cerebrospinal fluid flow with contrast injected into the lower spine. See what Aetna, Anthem BCBS, Cigna, UnitedHealthcare look for before approving it, the conditions their guidelines cover, and what it typically costs.

CPT 78630

Conducting a nuclear medicine study to assess cerebrospinal fluid flow with contrast injected into the lower spine.

Nuclear Medicine

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026	4 that name this code
Anthem BCBS	Carelon	Nuclear medicine imaging effective Sep 19, 2026	4 that name this code
Cigna	eviCore	Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head 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	4 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 Conducting a nuclear medicine study to assess cerebrospinal fluid flow with contrast injected into the lower spine. Each has its own criteria for when the study is considered appropriate.

Headache Aetna · Cigna · UnitedHealthcare
Nuclear Medicine Aetna · UnitedHealthcare
Macrocephaly, Microcephaly, and Hydrocephalus Aetna · Cigna · UnitedHealthcare
Brain and spinal cord malignancies Anthem BCBS
Cerebrospinal fluid leak of the skull base Anthem BCBS
Hydrocephalus/ventricular assessment, when MRI cannot be performed or is nondiagnostic Anthem BCBS
Spontaneous (idiopathic) intracranial hypotension, when MRI cannot be performed or is nondiagnostic Anthem BCBS

Typical price

Commercial insurance, median

$932

Middle half of rates: $612 to $1,646

Medicare, hospital outpatient

$555

Facility payment

Medicare, physician fee schedule

$296

National, non-facility

Commercial figures come from negotiated rates published by 773 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 Conducting a nuclear medicine study to assess cerebrospinal fluid flow with contrast injected into the lower spine change.

CPT 78630: Conducting a nuclear medicine study to assess cerebrospinal fluid flow with contrast injected into the lower spine - 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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