2025 CPT code 78801
(Active) 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); planar, 2 or more areas (e.g., abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or more days.
Modifiers 26 (professional component) and TC (technical component) can be applied.
Medical necessity must be established based on the patient’s symptoms, clinical history, and other diagnostic findings. The use of this code should be supported by appropriate documentation demonstrating the need for radiopharmaceutical localization.
The physician administers the radiopharmaceutical, supervises the imaging procedure, interprets the images, and formulates a diagnosis or treatment plan based on the findings.
In simple words: A radioactive material is injected to help locate tumors, inflammation, or track how a medication is distributed in your body. Pictures are taken with a special camera over one or more days, covering two or more body areas (like the abdomen and pelvis), or a single area over multiple days. This helps doctors diagnose and monitor conditions.
This code represents the localization of a tumor or inflammatory process, or the evaluation of the distribution of a radiopharmaceutical agent, using planar nuclear medicine imaging techniques. It includes vascular flow and blood pool imaging when performed. The service can involve imaging of two or more areas on one or more days (e.g., abdomen and pelvis), or imaging of a single area over two or more days.Radiolabeled monoclonal antibodies are administered, which react with specific tumor cell antigens, aiding in localization. Alternatively, a radioactive tracer is used to track the distribution of a substance within the body. A gamma camera detects the emitted gamma rays, creating planar images that are analyzed to assess anatomy and detect pathology.
Example 1: A patient with suspected lymphoma undergoes planar imaging of both the neck and chest to assess the extent of the disease., A patient with Crohn's disease undergoes labeled white blood cell imaging of the abdomen and pelvis over two days to localize areas of inflammation., A patient with a history of melanoma undergoes a whole-body scan to detect the presence of metastatic disease, with imaging performed over two days.
Documentation should include the medical necessity for the procedure, the radiopharmaceutical used, the areas imaged, the dates of imaging, and the interpretation of the findings.
- Modifier TC rule: Modifier TC is applicable when reporting the technical component only.
- Specialties:Nuclear Medicine, Radiology, Oncology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Independent Clinic, Physician's Office