Summary & Overview
CPT 78201: Liver and Spleen Scan, Diagnostic Nuclear Medicine
CPT code 78201 denotes a liver and spleen scan, a diagnostic nuclear medicine procedure used to image hepatic and splenic anatomy and function. Nationally, this code matters for clinicians and payers because it supports diagnosis and monitoring of focal lesions, splenic sequestration, and functional abnormalities that can affect care pathways for hepatology and oncology patients. Billing accuracy and appropriate site-of-service designation affect utilization patterns and payment.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and typical sites of service, payer coverage considerations, and common modifiers used with the code. The publication also summarizes national benchmarking context where available and highlights areas where policy updates or payer guidelines commonly influence billing and prior authorization requirements.
This piece provides clinicians, coding professionals, and policy analysts with the clinical context for 78201, a summary of payer landscape, and the types of documentation and coding details often needed to support medical necessity determinations. Data not available in the input for specific associated taxonomies, ICD-10 mappings, and related codes is noted elsewhere in the full publication.
Billing Code Overview
CPT code 78201 describes a liver and spleen scan, a specialized nuclear medicine imaging procedure used to examine the anatomy and function of the liver and spleen. The service uses radiologic scanning techniques to identify focal lesions, assess organ size and distribution, and evaluate functional aspects of these organs.
Service Type: Diagnostic nuclear medicine imaging
Typical Site of Service: Hospital outpatient imaging departments, freestanding imaging centers, and specialized nuclear medicine clinics
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of chronic liver disease and intermittent left upper quadrant pain is referred for a nuclear medicine liver and spleen scan to evaluate organ size, focal lesions, and splenic function. The typical clinical workflow begins with an order from the hepatology or internal medicine service. Nursing confirms allergy history and whether the patient is pregnant or breastfeeding. The nuclear medicine technologist explains the procedure, obtains intravenous access, and administers the radiopharmaceutical (commonly technetium-labeled colloid). Imaging is performed in the nuclear medicine department using planar and, if indicated, SPECT acquisition to assess hepatic and splenic uptake patterns. A radiologist or nuclear medicine physician interprets the study, documents findings such as focal defects, splenic sequestration, or functional asplenia, and transmits a report to the referring provider. Typical sites of service are the hospital outpatient imaging center, hospital radiology department, or freestanding outpatient imaging center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the interpreting physician's professional component is billed separate from technical services |
52 |