Which payers have published criteria for PET/CT whole body (CPT 78816)?

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 whole body (CPT 78816)?

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 whole body (CPT 78816)?

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 whole body (CPT 78816) cost?

Across 767 hospitals that publish their negotiated rates, the median commercial insurance rate is $3,573, with the middle half of rates between $2,203 and $5,846. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if PET/CT whole body (CPT 78816) 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 78816: PET/CT whole body - Prior Authorization and Price

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CPT 78816

Nuclear and CT imaging study of the entire body.

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 Neck Imaging Guidelines 1.0.2026, effective Feb 3, 2026	56 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 Neck Imaging Guidelines 1.0.2026, effective Feb 3, 2026	56 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	55 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 whole body. Each has its own criteria for when the study is considered appropriate.

Non-Hodgkin Lymphomas Aetna · Cigna · UnitedHealthcare
Melanomas and Other Skin Cancers Aetna · Cigna · UnitedHealthcare
Sarcomas – Bone, Soft Tissue, and GIST Aetna · Cigna · UnitedHealthcare
Multiple Myeloma and Plasmacytomas Aetna · Cigna · UnitedHealthcare
Hodgkin Lymphoma Aetna · Cigna · UnitedHealthcare
Metastatic Cancer, Carcinoma of Unknown Primary Site, and Other Types of Cancer Aetna · Cigna · UnitedHealthcare
Prostate Cancer Aetna · Cigna · UnitedHealthcare
Breast Cancer Aetna · Cigna · UnitedHealthcare
Leukemias, Myelodysplasia and Myeloproliferative Neoplasms Aetna · Cigna · UnitedHealthcare
Medical Conditions with Cancer in the Differential Diagnosis Aetna · Cigna · UnitedHealthcare
Primary Central Nervous System Tumors Aetna · Cigna · UnitedHealthcare
Histiocytic Disorders Aetna · Cigna · UnitedHealthcare
Pediatric Lymphomas Aetna · Cigna · UnitedHealthcare
Screening Imaging in Cancer Predisposition Syndromes Aetna · Cigna · UnitedHealthcare
Bone Tumors Aetna · Cigna · UnitedHealthcare
Pediatric Soft Tissue Sarcomas Aetna · Cigna · UnitedHealthcare
CNS Tumors Aetna · Cigna · UnitedHealthcare
Neuroblastoma Aetna · Cigna · UnitedHealthcare
Pediatric Leukemias Aetna · Cigna · UnitedHealthcare
Pediatric Liver and Pancreatic Tumors Aetna · Cigna · UnitedHealthcare
Pediatric Nasopharyngeal Carcinoma Aetna · Cigna · UnitedHealthcare
Thyroid and Parathyroid Aetna · Cigna · 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

$3,573

Middle half of rates: $2,203 to $5,846

Medicare, hospital outpatient

$1,461

Facility payment

Medicare, physician fee schedule

$112

National, non-facility

Commercial figures come from negotiated rates published by 767 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 whole body change.

CPT 78816: PET/CT 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

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CPT 78816: PET/CT 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

Related studies

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET