2025 CPT code 78816

PET/CT scan of the whole body for tumor imaging, attenuation correction, and anatomical localization.

Report 78816 only once per imaging session. Modifiers PI and PS are used to indicate the initial and subsequent treatment strategy for tumors, respectively.

Modifiers are applicable. Common modifiers include 26 (professional component), TC (technical component), 59 (distinct procedural service), and 76 (repeat procedure by same physician). Modifiers PI (to inform initial treatment strategy) or PS (to inform subsequent treatment strategy) must also be used.

Medical necessity for 78816 is established when the procedure is performed to evaluate a specific clinical condition, such as suspected or known malignancy, where the combined metabolic and anatomical information provided by PET/CT is essential for diagnosis, staging, or treatment planning.The documentation should clearly demonstrate the clinical rationale for performing a whole-body PET/CT scan over other imaging modalities.

The radiologist is responsible for performing and interpreting the PET/CT scan. This includes administering the radiopharmaceutical tracer, acquiring the images, and generating a diagnostic report correlating the metabolic and anatomical findings.

IMPORTANT For limited area PET/CT imaging, see codes 78811-78815. If CT is performed separately for diagnostic purposes, use the appropriate site-specific CT code with modifier 59.

In simple words: This procedure combines two types of scans, PET and CT, to create a detailed image of the whole body.Before the scan, you'll receive an injection of a special tracer. The PET scan shows how your cells are working, and the CT scan provides a clear picture of your organs and tissues.By combining these scans, doctors can get a very precise view of what's happening inside your body, which is especially helpful for finding and evaluating cancer.

Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; whole body. This code represents a comprehensive imaging procedure combining PET and CT for whole-body imaging.The PET scan utilizes a radiopharmaceutical tracer to visualize metabolic activity, while the CT scan provides detailed anatomical information. The concurrent acquisition allows for precise correlation of metabolic and anatomical findings, particularly useful in oncological imaging for tumor detection, staging, and treatment response assessment.Note: Computed tomography (CT) performed for other than attenuation correction and anatomical localization is reported using the appropriate site-specific CT code with modifier 59.

Example 1: A patient with suspected lymphoma undergoes a whole-body PET/CT scan (78816) to assess the extent of the disease and identify sites of involvement., A patient with melanoma undergoes a post-treatment whole-body PET/CT scan (78816) to evaluate the response to therapy and detect any residual or recurrent disease., A patient with a history of lung cancer undergoes a surveillance whole-body PET/CT scan (78816) to screen for recurrence.

Documentation should include the medical necessity for the PET/CT scan, the patient's relevant medical history, the radiopharmaceutical tracer used, the dosage administered, the acquisition parameters of the scan, and the radiologist's interpretation of the findings.

** This information is current as of December 1, 2024.Coding and reimbursement guidelines are subject to change, and it is essential to consult the most up-to-date resources for accurate billing and reporting.

  • Payment Status: Active
  • Modifier TC rule: Modifier TC can be used to report the technical component only.
  • Specialties:Nuclear Medicine, Radiology, Oncology, Cardiology, Neurology
  • Place of Service:Office, Outpatient Hospital, Independent Clinic, and other facilities where PET/CT imaging is available.
** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.