2025 CPT code 78803
(Revised) Effective Date: N/A Revision Date: N/A Radiology - Nuclear Medicine Feed
Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single area (e.g., head, neck, chest, pelvis) or acquisition, single day imaging.
Modifiers 26 (Professional Component) and TC (Technical Component) can be applied. Modifier 26 is used when only the interpretation of the results is being billed. Modifier TC is used when billing for the equipment, supplies, and technical staff involved in the procedure, but not the interpretation.
Medical necessity must be established for each SPECT scan. This usually involves demonstrating that the information obtained from the scan is necessary for diagnosis or treatment planning and couldn't be obtained through less invasive methods.
In simple words: This procedure uses a nuclear imaging test called SPECT to find the location of a tumor, inflammation, or other medical issue in one area of your body, like the head, chest, or pelvis. It's usually done in a single day. The doctor injects a small amount of radioactive material into your bloodstream, which helps the special camera create 3D images. This helps them see which tissues are more active and identify problem areas.
This code represents single-day imaging of a single area (such as the head, neck, chest, or pelvis) or single-day imaging with a single acquisition using SPECT. It includes vascular flow and blood pool imaging, when performed. The provider administers a radiopharmaceutical agent, uses a SPECT machine to image the patient, reviews the images, and produces a formal report. This procedure helps localize tumors, inflammation, or other noteworthy radioactive tracer distributions.
Example 1: A patient presents with seizures that are difficult to control with medication. Brain SPECT imaging is performed to identify the location causing the seizures, helping to determine if surgery is an option., A patient has a suspected infection in their knee. A SPECT scan is performed on the affected knee to pinpoint the infection's location and assess its severity. This information helps guide treatment decisions., A patient is scheduled for surgery on their internal carotid artery. A cerebral blood flow SPECT scan is conducted to evaluate the blood flow to the brain and determine if there's enough collateral circulation before the surgery.
Documentation should include the medical necessity for the SPECT study, the area imaged, the radiopharmaceutical used, the acquisition protocol, the physician's interpretation of the images, and a formal report.
- Specialties:Nuclear Medicine, Radiology
- Place of Service:Office, Independent Clinic, Hospital, Outpatient Hospital