2025 CPT code 78804
(Active) Effective Date: N/A Revision Date: N/A Diagnostic - Other Diagnostic Nuclear Medicine Procedures Radiology Procedures > Nuclear Medicine Procedures Feed
Radiopharmaceutical localization of tumor, inflammatory process, or radiopharmaceutical agent distribution; whole body, requiring 2 or more days of imaging.
Modifiers 26 (professional component) and TC (technical component) may apply depending on the services performed. Other modifiers may be necessary based on specific clinical circumstances, such as 59 (distinct procedural service).
Medical necessity is established when there is a clinical indication for the detection and localization of a tumor or inflammatory process, and whole body imaging over multiple days is considered appropriate given the clinical presentation.
The provider administers the radiopharmaceutical, performs the imaging, and interprets the results.This may include a nuclear medicine physician, radiologist, or other qualified healthcare professional.
- Radiology Procedures > Nuclear Medicine Procedures
- Radiology Procedures > Nuclear Medicine Procedures > Other Diagnostic Nuclear Medicine Procedures
In simple words: This test uses a special radioactive substance to find tumors or inflammation in the body.It involves multiple scans over several days to create detailed images.
This CPT code encompasses a nuclear medicine procedure involving the administration of a gamma-emitting radioactive tracer to diagnose and locate tumors, inflammatory processes, or the distribution of a radiopharmaceutical agent.The procedure includes vascular flow and blood pool imaging if performed.Whole-body imaging is conducted over a minimum of two days. The provider injects radiolabeled monoclonal antibodies targeted at a specific cellular antigen, followed by imaging using an external gamma camera to detect gamma rays emitted by the radioactive substance. Planar images are generated and analyzed to assess the anatomy and identify pathology.
Example 1: A patient presents with suspected metastatic cancer.A whole-body radioimmunoscintigraphy scan (78804) is ordered to identify the extent of disease spread, requiring imaging over multiple days., A patient is being monitored for recurrent lymphoma after treatment.Serial whole-body scans (78804) over two or more days are performed to detect any new areas of involvement., A patient with an undiagnosed inflammatory condition undergoes whole-body imaging (78804) over multiple days to help pinpoint the location and extent of the inflammation.
* Detailed patient history, including symptoms and relevant medical history.* Indication for the procedure, clearly stating the clinical suspicion for tumor or inflammatory process.* Radiopharmaceutical used and its administration details (dose, route, and time).* Imaging protocol, including the number of days of imaging, areas scanned, and acquisition parameters.* Physician interpretation report, including image findings and clinical correlation.
** The supply of the radiopharmaceutical is not included in this code and must be billed separately using the appropriate HCPCS codes.
- Revenue Code: I1E (STANDARD IMAGING - NUCLEAR MEDICINE)
- Global Days: The global period is not explicitly defined for this code; however, it is implied that the multiple days of imaging are encompassed within a single global billing period.
- Payment Status: Active
- Modifier TC rule: Modifier TC applies when only the technical component (equipment and staff) is billed, and modifier 26 is used when only the professional interpretation is billed. In many cases, the hospital may not need to use the TC modifier.
- Specialties:Nuclear Medicine, Radiology, Oncology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center