2025 CPT code 78800
(Active) Effective Date: N/A Revision Date: N/A Radiology Procedures - Nuclear Medicine Procedures Radiology Feed
Radiopharmaceutical localization of tumor, inflammatory process, or radiopharmaceutical agent distribution; planar, single area, single-day imaging.
Modifiers 26 (professional component) and TC (technical component) can be appended as appropriate, based on the services provided and payer-specific policies. Modifier 59 may be used if appropriate to indicate a distinct procedural service.
Medical necessity for 78800 is established when there is a clinical indication for radiopharmaceutical localization of a tumor, inflammatory process, or radiopharmaceutical agent distribution in a specific area. This might include situations where other imaging modalities are inconclusive or not suitable.
The provider is responsible for administering the radiolabeled material, performing the imaging procedure using a gamma camera, analyzing the images, and interpreting the results to identify and localize the tumor or inflammatory process. They may also perform vascular flow and blood pool imaging as part of the procedure.
In simple words: This test uses a special dye with a small amount of radioactivity to find tumors or inflammation in one part of the body. Pictures are taken to show where the dye goes.The test might also show how well the heart is pumping blood.
This CPT code describes the radiopharmaceutical localization of a tumor, inflammatory process, or the distribution of a radiopharmaceutical agent in a single body area using planar (two-dimensional) imaging.It includes vascular flow and blood pool imaging if performed and is reported for single-day imaging of a single area (e.g., head, neck, chest, pelvis). The procedure involves administering or injecting radiolabeled monoclonal antibodies, followed by imaging with a gamma camera. The provider analyzes the images to assess anatomy and detect/localize pathology.This procedure is also known as radioimmunoscintigraphy.
Example 1: A patient presents with a suspected lung tumor. The provider administers a radiolabeled monoclonal antibody that targets lung cancer cells. Planar imaging is performed to identify the location and size of the tumor., A patient has an inflammatory process in the neck area. A radiolabeled antibody targeting inflammatory cells is injected, followed by planar imaging to localize the inflammation., A patient undergoes a cardiac study to assess blood flow and ventricular function.As part of the cardiac imaging, planar images of the chest area are acquired to help assess the radiopharmaceutical agent distribution in the heart.
* Physician's order specifying the reason for the procedure.* Detailed report of the procedure including the radiopharmaceutical used, injection site, imaging techniques, and image interpretation.* Images obtained during the study.* Relevant clinical history and physical examination findings.
** The supply of the radiopharmaceutical is not included in this code. Use appropriate supply codes to bill separately.
- Revenue Code: I1E (STANDARD IMAGING - NUCLEAR MEDICINE)
- Payment Status: Active
- Modifier TC rule: Modifier TC may be applicable to the technical component of the service.
- Specialties:Nuclear Medicine, Oncology, Cardiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center