Who reviews prior authorization requests for Conducting a nuclear medicine study that examines several areas (CPT 78801)?

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 Conducting a nuclear medicine study that examines several areas (CPT 78801)?

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.

CPT 78801: Conducting a nuclear medicine study that examines several areas - Prior Authorization and Price

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CPT 78801

Conducting a nuclear medicine study that examines several areas.

Nuclear Medicine

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Abdomen 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	24 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 Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Peripheral Vascular Disease (PVD) Imaging Guidelines 2.0.2026, effective Sep 1, 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	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	24 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 that examines several areas. Each has its own criteria for when the study is considered appropriate.

Neuroendocrine Cancers and Adrenal Tumors 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
Nuclear Medicine Aetna · UnitedHealthcare
Adrenal Lesions Aetna · UnitedHealthcare
Infection/Osteomyelitis Aetna · UnitedHealthcare
Postoperative Pain within 60 Days Following Abdominal Surgery Aetna · UnitedHealthcare
Neuroblastoma Aetna · Cigna · UnitedHealthcare
Scalp and Skull Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Vascular Graft Infection Aetna · Cigna · UnitedHealthcare
Adrenal Cortical Lesions Aetna · UnitedHealthcare
Inflammatory Musculoskeletal Disease Aetna · UnitedHealthcare
Pediatric Back and Neck Pain and Trauma Aetna · UnitedHealthcare
Perioperative evaluation, not otherwise specified, including delayed hardware failure Anthem BCBS
Urinary Tract Infection (UTI) Aetna · UnitedHealthcare
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

Typical price

Commercial insurance, median

$774

Middle half of rates: $469 to $1,421

Medicare, hospital outpatient

$408

Facility payment

Medicare, physician fee schedule

$241

National, non-facility

Commercial figures come from negotiated rates published by 724 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 that examines several areas change.

CPT 78801: Conducting a nuclear medicine study that examines several areas - 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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