Which payers have published criteria for Nuclear imaging study using SPECT for one area (CPT 78803)?

The imaging guidelines used by Aetna, 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 using SPECT for one area (CPT 78803)?

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 using SPECT for one area (CPT 78803)?

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 78803: Nuclear imaging study using SPECT for one area - Prior Authorization and Price

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CPT 78803

Nuclear imaging study using SPECT for one area.

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 Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026	66 that name this code
Anthem BCBS	Carelon	Current guideline	None found
Cigna	eviCore	Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026	30 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	65 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 using SPECT for one area. Each has its own criteria for when the study is considered appropriate.

Thyroid Cancer Aetna · Cigna · UnitedHealthcare
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
Primary Central Nervous System Tumors Aetna · Cigna · UnitedHealthcare
Nuclear Medicine Aetna · UnitedHealthcare
Pediatric Back and Neck Pain and Trauma Aetna · UnitedHealthcare
Transplant Aetna · Cigna · UnitedHealthcare
Adrenal Lesions Aetna · UnitedHealthcare
Flank Pain, Renal Stone Aetna · UnitedHealthcare
Infection/Osteomyelitis Aetna · UnitedHealthcare
Inflammatory Musculoskeletal Disease Aetna · UnitedHealthcare
Limping Child Aetna · UnitedHealthcare
Liver Lesion Characterization Aetna · UnitedHealthcare
Postoperative Pain within 60 Days Following Abdominal Surgery Aetna · UnitedHealthcare
Suspected Physical Child Abuse Aetna · UnitedHealthcare
Bone Tumors Aetna · Cigna · UnitedHealthcare
Cerebrovascular Disease Aetna · Cigna · UnitedHealthcare
Epilepsy and Other Seizure Disorders Aetna · Cigna · UnitedHealthcare
Epilepsy/Seizures Aetna · Cigna · UnitedHealthcare
Lumbar Spine Spondylolysis/Spondylolisthesis Aetna · Cigna · UnitedHealthcare
Macrocephaly, Microcephaly, and Hydrocephalus Aetna · Cigna · UnitedHealthcare
Mediastinal Mass Aetna · Cigna · UnitedHealthcare
Mild Cognitive Impairment (MCI) and Dementia Aetna · Cigna · UnitedHealthcare
Neuroblastoma Aetna · Cigna · UnitedHealthcare
Scalp and Skull Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Spinal Compression Fractures Aetna · Cigna · UnitedHealthcare
Urinary Tract Infection (UTI) Aetna · Cigna · UnitedHealthcare
Vascular Graft Infection Aetna · Cigna · UnitedHealthcare
Adrenal Cortical Lesions Aetna · UnitedHealthcare
Avascular Necrosis (AVN) / Legg-Calvé-Perthes Disease / Idiopathic Osteonecrosis Aetna · UnitedHealthcare
Fracture and Dislocation Aetna · UnitedHealthcare
Liver Disease Aetna · UnitedHealthcare
Movement Disorders Aetna · UnitedHealthcare
Other Congenital and Pediatric Spine Disorders Aetna · UnitedHealthcare
Spleen Aetna · UnitedHealthcare

Typical price

Commercial insurance, median

$1,574

Middle half of rates: $1,158 to $2,324

Medicare, hospital outpatient

$555

Facility payment

Medicare, physician fee schedule

$337

National, non-facility

Commercial figures come from negotiated rates published by 941 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 using SPECT for one area change.

CPT 78803: Nuclear imaging study using SPECT for 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

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