Which payers have published criteria for Nuclear imaging study of one area (CPT 78800)?

The imaging guidelines used by Aetna, Anthem BCBS, Cigna, 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 study of one area (CPT 78800)?

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 study of one area (CPT 78800)?

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 Nuclear imaging study of one area (CPT 78800) cost?

Across 858 hospitals that publish their negotiated rates, the median commercial insurance rate is $677, with the middle half of rates between $433 and $1,197. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if Nuclear imaging study of one area (CPT 78800) 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 78800: Nuclear imaging study of one area - Prior Authorization and Price

Home › CPT Codes › Nuclear imaging study of one area

CPT 78800

Nuclear imaging study of one area.

Nuclear Medicine

Build a submission checklist for this study

Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Spine Imaging Guidelines 2.0.2026, effective Sep 1, 2026	25 that name this code
Anthem BCBS	Carelon	Nuclear medicine imaging effective Sep 19, 2026	12 that name this code
Cigna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Breast Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026	11 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	25 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 study of one area. Each has its own criteria for when the study is considered appropriate.

Perioperative evaluation, not otherwise specified, including delayed hardware failure Anthem BCBS
Fever of unknown origin, when contrast-enhanced CT cannot be performed or is nondiagnostic Anthem BCBS
Infectious and inflammatory conditions, not otherwise referenced Anthem BCBS
Lymphoma Anthem BCBS
Neuroendocrine cancer Anthem BCBS
Neuroendocrine tumors Anthem BCBS
Osteomyelitis and septic arthritis Anthem BCBS
Osteomyelitis of the skull base or calvarium, when CT or MRI cannot be performed or is nondiagnostic Anthem BCBS
Periprocedural imaging Anthem BCBS
Spinal infection, when MRI cannot be performed or is nondiagnostic Anthem BCBS
Nuclear Medicine Aetna · UnitedHealthcare
Adrenal Lesions Aetna · UnitedHealthcare
Infection/Osteomyelitis Aetna · UnitedHealthcare
Postoperative Pain within 60 Days Following Abdominal Surgery Aetna · UnitedHealthcare
Alternative Breast Imaging Approaches Aetna · Cigna · UnitedHealthcare
Mediastinal Mass Aetna · Cigna · UnitedHealthcare
Medical Conditions with Cancer in the Differential Diagnosis Aetna · Cigna · UnitedHealthcare
Metastatic Cancer, Carcinoma of Unknown Primary Site, and Other Types of Cancer Aetna · Cigna · UnitedHealthcare
Neuroblastoma Aetna · Cigna · UnitedHealthcare
Scalp and Skull Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Thyroid and Parathyroid Aetna · Cigna · UnitedHealthcare
Vascular Graft Infection Aetna · Cigna · UnitedHealthcare
Inflammatory Musculoskeletal Disease Aetna · UnitedHealthcare
Pediatric Back and Neck Pain and Trauma Aetna · UnitedHealthcare
Urinary Tract Infection (UTI) Aetna · UnitedHealthcare

Typical price

Commercial insurance, median

$677

Middle half of rates: $433 to $1,197

Medicare, hospital outpatient

$408

Facility payment

Medicare, physician fee schedule

$233

National, non-facility

Commercial figures come from negotiated rates published by 858 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 study of one area change.

CPT 78800: Nuclear imaging study of one area - 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