Which payers have published criteria for PET limited area (CPT 78811)?

The imaging guidelines used by Aetna, Anthem BCBS, Cigna, Medicare, 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 PET limited area (CPT 78811)?

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 PET limited area (CPT 78811)?

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 PET limited area (CPT 78811) cost?

Across 515 hospitals that publish their negotiated rates, the median commercial insurance rate is $2,044, with the middle half of rates between $1,567 and $3,446. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if PET limited area (CPT 78811) 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 78811: PET limited area - Prior Authorization and Price

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CPT 78811

Nuclear imaging study of a limited area.

PET Oncology

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Musculoskeletal Imaging Guidelines 2.0.2026, effective Sep 1, 2026	7 that name this code
Anthem BCBS	Carelon	Oncologic imaging effective Apr 4, 2026	1 that name this code
Cigna	eviCore	Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026	4 that name this code
Medicare	CMS	NCD 220.6.17: Positron Emission Tomography (FDG) for Oncologic Conditions effective Aug 17, 2026 NCD 220.6.19: Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer effective Feb 27, 2024 L39521: Positron Emission Tomography (PET) Scan for Inflammation and Infection (CGS Administrators) effective Jan 22, 2026	3 that name this code
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	8 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 PET limited area. Each has its own criteria for when the study is considered appropriate.

Mild Cognitive Impairment (MCI) and Dementia Aetna · Cigna · UnitedHealthcare
Cerebrovascular Disease Aetna · UnitedHealthcare
Primary Central Nervous System Tumors Aetna · Cigna · UnitedHealthcare
Nuclear Medicine Aetna · UnitedHealthcare
Histiocytic Neoplasms Anthem BCBS
Positron Emission Tomography (FDG) for Oncologic Conditions Medicare
Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer Medicare
Positron Emission Tomography (PET) Scan for Inflammation and Infection Medicare

Typical price

Commercial insurance, median

$2,044

Middle half of rates: $1,567 to $3,446

Medicare, hospital outpatient

$1,323

Facility payment

Medicare, physician fee schedule

$69

National, non-facility

Commercial figures come from negotiated rates published by 515 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 PET limited area change.

CPT 78811: PET limited 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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CPT 78811: PET limited 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

Related studies

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET