2025 CPT code 78814
(Active) Effective Date: N/A Revision Date: N/A Radiology Procedures - Nuclear Medicine Procedures Radiology Feed
Positron emission tomography (PET) scan with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; limited area (e.g., chest, head/neck).
Modifiers 26 (professional component), TC (technical component), and others may be applicable depending on the services performed and the payer's requirements.
Medical necessity for this procedure is established based on clinical indications, such as suspected malignancy, staging of known cancer, assessing response to therapy, or guiding surgical planning.The referring physician must document the clinical rationale justifying the need for the PET/CT scan.
The clinical responsibility includes administering the radiopharmaceutical, performing the PET/CT scan, interpreting the images, and generating a report for the referring physician. The ordering physician may also have the responsibility of coordinating patient care based on the results of the imaging.
In simple words: This is a special type of scan that combines two imaging techniques, PET and CT, to create detailed pictures of the inside of your body.A small amount of a radioactive substance is injected to help the PET scan show how well different parts of your body are working, which is particularly helpful in detecting and assessing tumors. The CT scan provides a detailed anatomical view to help pinpoint the exact location of abnormalities. Both images are combined to get a clearer picture of the problem area.
This diagnostic procedure involves a combined positron emission tomography (PET) and computed tomography (CT) scan using a hybrid PET/CT scanner.The PET scan uses a radioactive tracer injected into the bloodstream to visualize metabolic activity, particularly useful in detecting and characterizing tumors.The concurrently acquired CT provides anatomical detail, improving the accuracy and interpretation of the PET images. The fused images from both modalities allow for precise localization and characterization of lesions within a limited area such as the chest or head/neck.This integrated approach is crucial for staging cancer, evaluating treatment response, and guiding treatment planning. The code does not include the cost of the radiopharmaceutical.
Example 1: A 60-year-old male with a history of lung cancer presents for a PET/CT scan to evaluate for recurrence after treatment. Code 78814 is used to bill for the limited area scan of the chest., A 45-year-old female with a suspected head and neck mass undergoes a PET/CT to help characterize the lesion.Code 78814 is used to bill for the limited area scan., A 72-year-old patient with known metastatic melanoma undergoes a PET/CT scan to assess response to therapy. Code 78814 is applied if the scan focuses on a specific region like the neck or chest.
** The supply of the radiopharmaceutical is not included in this code and must be billed separately using appropriate supply codes.Always verify payer-specific coverage and billing guidelines.
- Revenue Code: I2D (Advanced Imaging - MRI: Other)
- RVU: Refer to the CMS Physician Fee Schedule for current RVU values.These values are subject to change and vary based on location and practice setting (non-facility vs. facility).
- Global Days : The global period is not defined for this procedure and would depend on payer specific rules and guidelines.
- Payment Status: Active
- Modifier TC rule: Modifier TC may be appended to indicate the technical component only, however, this is often determined by payer-specific rules and may not be required in all settings.
- Fee Schedule : Historical fee schedule data can be accessed through publicly available resources such as the CMS Physician Fee Schedule database.
- Specialties:Nuclear Medicine, Oncology, Radiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center