Which payers have published criteria for PET/CT skull base to mid-thigh (CPT 78815)?

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/CT skull base to mid-thigh (CPT 78815)?

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/CT skull base to mid-thigh (CPT 78815)?

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/CT skull base to mid-thigh (CPT 78815) cost?

Across 798 hospitals that publish their negotiated rates, the median commercial insurance rate is $3,441, with the middle half of rates between $2,099 and $5,827. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if PET/CT skull base to mid-thigh (CPT 78815) 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 78815: PET/CT skull base to mid-thigh - Prior Authorization and Price

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CPT 78815

Nuclear imaging study from the head to the mid-thigh with a CT scan.

PET Oncology

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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 and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Chest Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026	132 that name this code
Anthem BCBS	Carelon	Oncologic imaging effective Apr 4, 2026	1 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 Chest Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026	132 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	131 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/CT skull base to mid-thigh. Each has its own criteria for when the study is considered appropriate.

Metastatic Cancer, Carcinoma of Unknown Primary Site, and Other Types of Cancer Aetna · Cigna · UnitedHealthcare
Non-Hodgkin Lymphomas Aetna · Cigna · UnitedHealthcare
Neuroendocrine Cancers and Adrenal Tumors Aetna · Cigna · UnitedHealthcare
Upper GI Cancers Aetna · Cigna · UnitedHealthcare
Sarcomas – Bone, Soft Tissue, and GIST Aetna · Cigna · UnitedHealthcare
Melanomas and Other Skin Cancers Aetna · Cigna · UnitedHealthcare
Other Thoracic Tumors Aetna · Cigna · UnitedHealthcare
Anal Cancer & Cancers of the External Genitalia Aetna · Cigna · UnitedHealthcare
Cervical Cancer Aetna · Cigna · UnitedHealthcare
Colorectal and Small Bowel Cancer Aetna · Cigna · UnitedHealthcare
Hodgkin Lymphoma Aetna · Cigna · UnitedHealthcare
Non-Small Cell Lung Cancer Aetna · Cigna · UnitedHealthcare
Squamous Cell Carcinomas of the Head and Neck Aetna · Cigna · UnitedHealthcare
Multiple Myeloma and Plasmacytomas Aetna · Cigna · UnitedHealthcare
Breast Cancer Aetna · Cigna · UnitedHealthcare
Esophageal and GE Junction Cancer Aetna · Cigna · UnitedHealthcare
Ovarian Cancer Aetna · Cigna · UnitedHealthcare
Primary Central Nervous System Tumors Aetna · Cigna · UnitedHealthcare
Prostate Cancer Aetna · Cigna · UnitedHealthcare
Salivary Gland Cancers Aetna · Cigna · UnitedHealthcare
Small Cell Lung Cancer Aetna · Cigna · UnitedHealthcare
Testicular, Ovarian and Extragonadal Germ Cell Tumors Aetna · Cigna · UnitedHealthcare
Thyroid Cancer Aetna · Cigna · UnitedHealthcare
Transitional Cell Cancer Aetna · Cigna · UnitedHealthcare
Uterine Cancer Aetna · Cigna · UnitedHealthcare
Leukemias, Myelodysplasia and Myeloproliferative Neoplasms Aetna · Cigna · UnitedHealthcare
Medical Conditions with Cancer in the Differential Diagnosis Aetna · Cigna · UnitedHealthcare
Pancreatic Cancer Aetna · Cigna · UnitedHealthcare
Pediatric Renal Tumors Aetna · Cigna · UnitedHealthcare
Pediatric Lymphomas Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Abdominal Lymphadenopathy Aetna · Cigna · UnitedHealthcare
Brachial Plexus Aetna · Cigna · UnitedHealthcare
CNS Tumors Aetna · Cigna · UnitedHealthcare
Congestive Heart Failure Aetna · Cigna · UnitedHealthcare
Hematopoietic Stem Cell Transplantation (HSCT) Aetna · Cigna · UnitedHealthcare
Histiocytic Disorders Aetna · Cigna · UnitedHealthcare
Lung Cancer Screening Aetna · Cigna · UnitedHealthcare
Lymphadenopathy Aetna · Cigna · UnitedHealthcare
Mediastinal Mass Aetna · Cigna · UnitedHealthcare

Plus 17 more. Use the search below to find a specific condition.

Typical price

Commercial insurance, median

$3,441

Middle half of rates: $2,099 to $5,827

Medicare, hospital outpatient

$1,461

Facility payment

Medicare, physician fee schedule

$110

National, non-facility

Commercial figures come from negotiated rates published by 798 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/CT skull base to mid-thigh change.

CPT 78815: PET/CT skull base to mid-thigh - 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

CPT 78815: PET/CT skull base to mid-thigh - 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