Who reviews prior authorization requests for Nuclear imaging study of the whole body over multiple days (CPT 78804)?

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 over multiple days (CPT 78804)?

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 78804: Nuclear imaging study of the whole body over multiple days - Prior Authorization and Price

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CPT 78804

Nuclear imaging study of the whole body over multiple days.

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 Spine Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Abdomen Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	15 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 Pediatric Cardiac Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Pediatric Chest Imaging Guidelines 2.0.2026, effective Sep 1, 2026	8 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	15 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 over multiple days. 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
Adrenal Lesions Aetna · UnitedHealthcare
Nuclear Medicine Aetna · UnitedHealthcare
Mediastinal Mass Aetna · Cigna · UnitedHealthcare
Neuroblastoma Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Adrenal Cortical Lesions Aetna · UnitedHealthcare
Pediatric Back and Neck Pain and Trauma Aetna · UnitedHealthcare
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
Spinal infection, when MRI cannot be performed or is nondiagnostic Anthem BCBS

Typical price

Commercial insurance, median

$2,005

Middle half of rates: $1,298 to $3,193

Medicare, hospital outpatient

$555

Facility payment

Medicare, physician fee schedule

$564

National, non-facility

Commercial figures come from negotiated rates published by 838 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 over multiple days change.

CPT 78804: Nuclear imaging study of the whole body over multiple days - 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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