Which payers have published criteria for Nuclear imaging study of the whole body (CPT 78802)?

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 the whole body (CPT 78802)?

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 the whole body (CPT 78802)?

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 the whole body (CPT 78802) cost?

Across 844 hospitals that publish their negotiated rates, the median commercial insurance rate is $1,537, with the middle half of rates between $1,095 and $2,359. 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 the whole body (CPT 78802) 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 78802: Nuclear imaging study of the whole body - Prior Authorization and Price

Home › CPT Codes › Nuclear imaging study of the whole body

CPT 78802

Nuclear imaging study of the whole body.

Nuclear Medicine

Build a submission checklist for this study

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	26 that name this code
Anthem BCBS	Carelon	Nuclear medicine imaging effective Sep 19, 2026	11 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 Peripheral Vascular Disease (PVD) Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Cardiac 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	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	26 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 the whole body. 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
Nuclear Medicine Aetna · UnitedHealthcare
Adrenal Lesions Aetna · UnitedHealthcare
Infection/Osteomyelitis Aetna · UnitedHealthcare
Inflammatory Musculoskeletal Disease Aetna · UnitedHealthcare
Postoperative Pain within 60 Days Following Abdominal Surgery Aetna · UnitedHealthcare
Mediastinal Mass Aetna · Cigna · UnitedHealthcare
Neuroblastoma Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Vascular Graft Infection Aetna · Cigna · UnitedHealthcare
Adrenal Cortical Lesions Aetna · UnitedHealthcare
Other Congenital and Pediatric Spine Disorders 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
Spinal infection, when MRI cannot be performed or is nondiagnostic Anthem BCBS

Typical price

Commercial insurance, median

$1,537

Middle half of rates: $1,095 to $2,359

Medicare, hospital outpatient

$555

Facility payment

Medicare, physician fee schedule

$272

National, non-facility

Commercial figures come from negotiated rates published by 844 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 the whole body change.

CPT 78802: Nuclear imaging study of the whole body - 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