CPT 78195 Lymphatic Scintigraphy Reimbursement | OpenPayer

Summary & Overview

CPT 78195: Lymphatic and Lymph Node Scintigraphy

CPT code 78195 denotes a nuclear medicine diagnostic procedure that employs a gamma–emitting radioactive tracer to image and localize disease within the lymphatics and lymph nodes. Nationally, this code is used in evaluation of lymphatic mapping, sentinel node identification, and detection of lymphatic obstruction or metastatic involvement, making it important for oncology staging and surgical planning. Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical context and typical sites of service for CPT code 78195, common billing considerations, and payer coverage patterns. The publication provides benchmarks and coding guidance relevant to radiology and nuclear medicine service lines, and summarizes how payers commonly handle authorization and reimbursement for lymphatic scintigraphy. It also highlights areas where policy updates or payer-specific rules can affect utilization and claim adjudication. Data not available in the input for specific payer policies, associated taxonomies, and ICD-10 diagnoses are noted as unavailable where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare78195CPTnuclear-medicinelymphatic-imagingsentinel-nodediagnostic-imagingradiologyoncology

Billing Code Overview

CPT code 78195 describes a nuclear medicine procedure in which a provider uses a gamma–emitting radioactive tracer to diagnose and localize diseases of the lymphatics and lymph nodes. This procedure is a form of lymphatic and lymph node scintigraphy used to visualize lymphatic drainage patterns and identify sentinel or abnormal lymph nodes.

Service type: Diagnostic nuclear medicine imaging using a gamma–emitting tracer
Typical site of service: Outpatient imaging center, hospital radiology or nuclear medicine department

Clinical & Coding Specifications

Clinical Context

A typical patient is a 55-year-old female with newly diagnosed cutaneous melanoma on the lower leg scheduled for sentinel lymph node mapping prior to wide local excision. The nuclear medicine team administers a gamma-emitting radiotracer (technetium-99m sulfur colloid) via intradermal injections around the primary lesion in preoperative holding. Dynamic and static lymphoscintigraphy images are acquired to identify the sentinel lymph node basin. The nuclear medicine physician marks the skin overlying the hottest node and provides a report documenting tracer injection sites, lymphatic drainage pattern, and location of sentinel nodes. The surgical team uses the localization information intraoperatively with a handheld gamma probe to guide sentinel lymph node biopsy. Typical workflow steps: preauthorization and scheduling; patient check-in and consent; radiotracer preparation and injection; imaging acquisition (planar/dynamic); image interpretation and skin marking; postoperative reporting and coordination with surgical scheduling.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation/reporting of the imaging study separate from technical imaging services.
`TC`

CPT 78122: Whole Blood Volume Study via Isotope Dilution

CPT-78140-LIVER-SPLEEN-RADIOLABELED-RED-BLOOD-CELL-SCAN

CPT 78140: Liver and Spleen Scan with Radiolabeled Autologous Red Blood Cells

CPT-78120-RADIOLABELED-SINGLE-SAMPLE-RED-CELL-VOLUME

CPT 78120: Single-Sample Radiolabeled Red Cell Volume Determination

CPT-78130-RED-BLOOD-CELL-SURVIVAL-STUDY-AUTOLOGOUS-RADIOLABEL

CPT 78130: Red Blood Cell Survival Study, Autologous Radiolabel

CPT-78104-WHOLE-BODY-BONE-SCAN

CPT 78104: Whole-Body Bone Scan, Skeletal Scintigraphy

CPT-78121-RED-CELL-VOLUME-MULTIPLE-SAMPLE-METHOD

CPT 78121: Red Cell Volume Measurement, Multiple Sample Method

CPT-78199-HEMATOPOIETIC-LYMPHATIC-NUCLEAR-MEDICINE-DIAGNOSTIC

CPT 78199: Hematopoietic and Lymphatic Diagnostic Nuclear Medicine

CPT-78103-NUCLEAR-MEDICINE-BONE-SCAN

CPT 78103: Nuclear Medicine Bone Scan, Whole Body/Multi-Phase

CPT-78110-SINGLE-SAMPLE-PLASMA-VOLUME-DETERMINATION

CPT 78110: Single-Sample Plasma Volume Determination

CPT-78111-PLASMA-VOLUME-MULTIPLE-SAMPLE-METHOD

CPT 78111: Plasma Volume Measurement, Multiple Sample Method

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Taxonomy Code	Specialty	Notes
174500000X	Radiology	Diagnostic imaging interpretation and procedural oversight for lymphoscintigraphy and nuclear medicine studies.
183500000X	Nuclear Medicine	Primary specialty performing radiotracer injection, image acquisition, and interpretation.
207L00000X	General Surgery	Surgeon who uses localization results to perform sentinel lymph node biopsy.
207K00000X	Surgical Oncology	Common specialist ordering and acting on sentinel node mapping for cancer staging.
207RC0000X	Dermatology	Often involved for primary skin lesion diagnosis and coordination of sentinel node procedures for cutaneous malignancies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C43.7`	Malignant melanoma of lower limb, including hip	Common indication for sentinel lymph node mapping to stage melanoma and detect regional nodal metastasis.
`C43.9`	Malignant melanoma, unspecified	Used when melanoma is the underlying malignancy prompting lymphatic mapping when site specifics are not coded.
`C77.9`	Secondary and unspecified malignant neoplasm of lymph nodes	May indicate suspected nodal involvement requiring localization and evaluation.
`D49.3`	Neoplasm of uncertain behavior of skin	When lesion behavior is uncertain and staging with sentinel node mapping is considered.
`C50.9`	Malignant neoplasm of breast, unspecified	Breast cancer commonly uses lymphoscintigraphy for sentinel node mapping prior to surgical biopsy.
`Z85.820`	Personal history of malignant melanoma of skin	Surveillance or preoperative mapping in patients with prior melanoma history undergoing evaluation for recurrence.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`38525`	Biopsy or excision of lymph node(s); open, deep axillary node(s)	May be performed after sentinel node localization when an identified node is surgically excised for pathology.
`38792`	Lymphatic mapping, radiopharmaceutical agent, with imaging; with intraoperative guidance (eg, gamma probe)	Complementary or subsequent procedure capturing combined mapping with intraoperative gamma probe localization.
`78800`	Radiopharmaceutical localization of a sentinel node using lymphoscintigraphy (includes imaging)	Alternative or related nuclear medicine code for sentinel node localization imaging in certain payer schedules; may overlap with `78195` depending on documentation and payer definitions.
`96440`	Injection administration of chemotherapeutic agent; intraperitoneal (example of injection codes)	Not directly related but illustrates coding for administration procedures; injectable radiotracer administration is typically included in the technical component of the nuclear medicine code rather than billed separately.
`88305`	Level IV surgical pathology, gross and microscopic examination	Used for pathologic evaluation of excised sentinel lymph nodes after biopsy to determine metastasis.

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