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CPT 78709: Conducting nuclear medicine studies to evaluate kidney function and blood flow - Prior Authorization and Price

CPT code 78709 is Conducting nuclear medicine studies to evaluate kidney function and blood flow. See what Aetna, Anthem BCBS, Cigna, UnitedHealthcare look for before approving it, the conditions their guidelines cover, and what it typically costs.

CPT 78709

Conducting nuclear medicine studies to evaluate kidney function and blood flow.

Nuclear Medicine
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Payer guidelines that apply

PayerReviewed usingGuidelineSections
Aetna eviCore
Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026
Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026
 14 that name this code
Anthem BCBS Carelon
Nuclear medicine imaging effective Sep 19, 2026
 7 that name this code
Cigna eviCore
Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026
Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026
 9 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 14 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 nuclear medicine studies to evaluate kidney function and blood flow. Each has its own criteria for when the study is considered appropriate.

  • Flank Pain, Rule Out or Known Renal/Ureteral Stone Aetna · Cigna · UnitedHealthcare
  • Renal Failure Aetna · UnitedHealthcare
  • Hydronephrosis Aetna · Anthem BCBS · Cigna · UnitedHealthcare
  • Hematopoietic Stem Cell Transplantation (HSCT) Aetna · Cigna · UnitedHealthcare
  • Indeterminate Renal Lesion Aetna · Cigna · UnitedHealthcare
  • Flank Pain, Renal Stone Aetna · UnitedHealthcare
  • Renovascular Hypertension and Other Secondary Causes of Hypertension Aetna · Cigna · UnitedHealthcare
  • Urinary Tract Infection (UTI) Aetna · Cigna · UnitedHealthcare
  • Congenital and developmental conditions, not otherwise specified Anthem BCBS
  • Kidney cancer/Renal cell carcinoma Anthem BCBS
  • Perioperative evaluation, not otherwise specified, including transplant Anthem BCBS
  • Renal artery stenosis/Renovascular hypertension Anthem BCBS
  • Trauma, not otherwise specified Anthem BCBS
  • Urinary tract infection (Pediatric only) Anthem BCBS

Typical price

Commercial insurance, median
$955
Middle half of rates: $659 to $1,691
Medicare, hospital outpatient
$555
Facility payment
Medicare, physician fee schedule
$328
National, non-facility

Commercial figures come from negotiated rates published by 746 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 nuclear medicine studies to evaluate kidney function and blood flow change.

Frequently asked questions

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