2025 CPT code 78811
(Active) Effective Date: N/A Revision Date: N/A Radiology - Nuclear Medicine Procedures Radiology Feed
Positron emission tomography (PET) imaging of a limited area (e.g., chest, head/neck).
Modifiers 26 (professional component) and TC (technical component) may be appended to 78811 depending on the services provided.Refer to payer guidelines for specific rules regarding modifier usage.
Medical necessity for a limited area PET scan is established based on the clinical indication, such as evaluating a suspicious lesion, staging cancer, assessing treatment response, or detecting recurrence.The ordering physician must document the medical necessity in the patient's chart.
A physician specializing in radiology, nuclear medicine, or oncology is typically responsible for ordering and interpreting the PET scan.The nuclear medicine technologist administers the tracer and performs the scan.The interpreting physician reviews the images, correlates them with the patient's clinical presentation, and produces a report.
In simple words: This test uses a special scan (PET) to create detailed pictures of a specific part of your body, like your chest or neck.A small amount of a safe radioactive substance is injected into your bloodstream to help the scanner create the images.This helps doctors see how cells are working in that area to find problems like tumors.
CPT code 78811 represents Positron Emission Tomography (PET) imaging performed on a limited area of the body, such as the chest, head, or neck.This nuclear medicine procedure involves injecting a radioactive tracer into the patient's bloodstream. The tracer accumulates in areas of high metabolic activity, which are then visualized by the PET scanner.The resulting images help in detecting and characterizing various conditions, particularly tumors and other metabolically active lesions. The "limited area" specification distinguishes this code from those encompassing whole-body PET scans.
Example 1: A patient presents with a suspicious lung nodule detected on a chest X-ray. A limited area PET scan of the chest is ordered to determine if the nodule is malignant and to assess its extent., A patient with a history of head and neck cancer undergoes a follow-up limited area PET scan of the head and neck to evaluate for recurrence after treatment., A patient with suspected lymphoma undergoes a limited area PET scan of the neck and chest to assess the extent of disease and guide treatment decisions.
* Physician's order specifying the clinical indication for the PET scan.* Patient's medical history and relevant physical examination findings.* Results of other relevant imaging studies.* Radiotracer used and its dosage.* Images obtained from the PET scan.* Radiologist's interpretation report.
** The use of 78811 is dependent on the extent of the scan area.If the scan extends beyond a limited area, a different code may be required. Always ensure proper documentation to support medical necessity and accurate coding.
- RVU: Refer to the current Medicare Physician Fee Schedule (MPFS) for relative value units (RVUs) and reimbursement rates. These values are subject to change and vary by geographic location.
- Payment Status: Active
- Modifier TC rule: The TC modifier may be appropriate if only the technical component of the PET scan (image acquisition) is billed, and the professional component (interpretation) is billed separately using modifier 26.
- Fee Schedule : Historical fee schedule data is available through the CMS website and other commercial databases.These fees vary by year and payer.
- Specialties:Nuclear Medicine, Radiology, Oncology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Office