2025 CPT code 78831

Radiopharmaceutical localization of tumor, inflammatory process, or distribution of radiopharmaceutical agent(s), including vascular flow and blood pool imaging; tomographic (SPECT), minimum 2 areas (e.g., pelvis and knees, chest and abdomen) or separate acquisitions (e.g., lung ventilation and perfusion), single-day imaging, or single area or acquisition over 2 or more days.

Ensure that the documentation supports the use of two separate areas or acquisitions or the necessity for a single area over multiple days. Note that the radiopharmaceutical itself is billed separately. Modifiers may apply based upon who performs the professional or technical aspects of the procedure, or if a distinct procedure also occurred.

Modifiers such as 26 (professional component), TC (technical component), 59 (distinct procedural service), and 76 (repeat procedure by same physician) may be applicable. Refer to current CPT guidelines and payer policies for correct modifier usage.

Medical necessity must be established for the SPECT scan. Documentation should support the clinical rationale for the procedure based on the patient's symptoms, signs, or other diagnostic findings.

The physician administers a radiopharmaceutical, typically intravenously. They select an appropriate patient-specific acquisition protocol for the SPECT scanner and position the patient. The scanner detects the emitted gamma rays, and a computer generates 3D images. The physician reviews the images and creates a report for the medical record. This code includes responsibility for ensuring adequate SPECT data quality.

In simple words: This procedure uses a special type of scan called SPECT to find tumors, inflammation, or track special radioactive materials in the body. It can also show blood flow. The scan takes 3D pictures of at least two areas of your body, like your pelvis and knees, or different scans of one area, like your lungs, all in one day. It can also be used if the scan of one area happens over more than one day.

This code describes a procedure where a radiopharmaceutical agent is administered to locate a tumor, inflammatory process, or trace the distribution of the agent. It includes vascular flow and blood pool imaging when performed. The procedure uses Single Photon Emission Computed Tomography (SPECT) to create tomographic images. It covers imaging of at least two distinct areas (like pelvis and knees, or chest and abdomen) or separate acquisitions (like lung ventilation and perfusion) in a single day. Alternatively, it can be used for imaging a single area or acquisition over two or more days.

Example 1: A patient presents with suspected bone metastasis in the pelvis and knees. A SPECT scan is performed on the same day using 78831 to evaluate both areas., A patient with suspected pulmonary embolism undergoes lung ventilation and perfusion scans on the same day, using 78831 to account for both acquisitions., A patient requires a whole-body bone scan that is performed over two consecutive days. This scenario also uses 78831 because it involves imaging a single area over multiple days.

Documentation must include details of the radiopharmaceutical used, the areas imaged or acquisitions performed, the reason for the study (e.g., suspicion of tumor, inflammation), the interpretation of the images, and any relevant clinical findings.

  • Specialties:Nuclear Medicine, Radiology, Oncology
  • Place of Service:Inpatient Hospital, Outpatient Hospital, Independent Clinic, and other locations where nuclear medicine services are provided.
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