These CPT codes have been assigned by the American Medical Association (AMA) for PET and PET/CT scanning services! In an effort to keep you informed about these updates, we have listed the CPT codes below.
CPT Code Guidelines for Private Payers |
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| Type of Study | PET/CT |
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| Tumor Imaging, limited | 78814 |
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| Tumor Imaging, base of skull-thigh | 78815 |
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| Tumor Imaging, full body | 78816 |
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| Brain Imaging, metabolic evaluation | 78608 |
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| Brain Imaging, perfusion evaluation | 78609 |
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| Myocardial Imaging, metabolic evaluation | 78459 |
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PLEASE NOTE: If pre-authorization is necessary from a private insurer, please make sure that these CPT codes are utilized. Failure to utilize these codes may result in your patients’ PET/CT scan claim getting denied from their insurance company.
If you have any questions regarding these new changes or if you are unsure of how to code that particular patient, please feel free to call us and we can help you properly protocol and code the study.
Oncology Clinical Indications
| Brain Tumor |
| • Differentiate recurrent tumor from radiation necrosis • Differentiate primary CNS lymphoma from toxoplasmosis • Exclude metastatic disease of the brain |
| Breast Cancer |
| • Identify involved axillary nodes or distant metastatic
disease • Exclude local recurrence of disease • Evaluate response to treatment |
| Cervical Cancer |
| • Detect pre-treatment metastases in newly diagnosed cancer |
| Colorectal Cancer |
| • Detect locally recurrent or distant metastatic disease
in patients with elevated or rising CEA who may be candidates for surgical re-excision • Rule out distant metastases for preoperative evaluation |
| Esophageal Cancer |
| • Evaluate local extent of disease, and exclude distant metastases • Evaluate disease to determine surgical appropriateness |
| Head & Neck Cancer |
| • Determine extent of local, regional, and distant disease • Detect recurrent/residual tumor following definitive therapy |
| Lung Cancer |
| • Distinguish malignant from benign pulmonary nodules • Stage for mediastinal or distant metastatic disease • Use as part of radiotherapy treatment planning • Detect recurrent/residual tumor following definitive therapy |
| Lymphoma |
| • Determine extent of disease • Measure treatment response |
| Melanoma |
| • Identify extent of local and regional disease spread in
patients with high risk melanoma (e.g., primary tumor ≥4mm), or in suspected recurrence |
| Musculoskeletal Tumors |
| • Evaluate local extent of disease and exclude distant metastases • Measure treatment response and exclude recurrent/residual tumor following definitive therapy |
| Ovarian Cancer |
| • Detect recurrent/residual tumor prior to surgical exploration
or additional chemotherapy |
| Pancreatic Cancer |
| • Differentiation of benign processes such as pancreatitis, mucinous cyst adenoma and pseudocyst from malignant disease • Rule out distant metastases for preoperative evaluation |
| Thyroid Cancer |
| • Detect metastatic or locally recurrent disease in patients
with elevated thyroglobulin after definitive initial treatment and negative I-131 examination |
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References Conti, P.S., Lilien, D.L., Howley, K., Keppler, J., Grafton, S.T., Bading, J., PET and F-18 FDG in Oncology: A Clinical Update. Nuclear Medicine and Biology, (1996) 23:717-735. Di Chiro, G., Positron Emission Tomography Using FDG in Brain Tumors: A Powerful Diagnostic and Prognostic Tool. Investigational Radiology,(1986) 2:360-371. |