Which payers have published criteria for Nuclear imaging to assess kidney function (CPT 78725)?

The imaging guidelines used by Aetna, Anthem BCBS, 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 Nuclear imaging to assess kidney function (CPT 78725)?

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 Nuclear imaging to assess kidney function (CPT 78725)?

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.

What can be done if Nuclear imaging to assess kidney function (CPT 78725) 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 78725: Nuclear imaging to assess kidney function - Prior Authorization and Price

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CPT 78725

Nuclear imaging to assess kidney function.

Nuclear Medicine

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026	1 that name this code
Anthem BCBS	Carelon	Nuclear medicine imaging effective Sep 19, 2026	7 that name this code
Cigna	eviCore	Current guideline	None found
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	1 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 to assess kidney function. Each has its own criteria for when the study is considered appropriate.

Congenital and developmental conditions, not otherwise specified Anthem BCBS
Hydronephrosis 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
Urinary Tract Infection (UTI) Aetna · UnitedHealthcare

Typical price

Commercial insurance, median

$541

Middle half of rates: $420 to $814

Medicare, hospital outpatient

$408

Facility payment

Medicare, physician fee schedule

$100

National, non-facility

Commercial figures come from negotiated rates published by 546 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 to assess kidney function change.

CPT 78725: Nuclear imaging to assess kidney function - 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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