Summary & Overview
CPT 78290: Meckel's Scan (Radionuclide Intestinal Imaging)
CPT code 78290 designates a radionuclide intestinal imaging study (Meckel's scan) used to detect ectopic gastric mucosa within a Meckel's diverticulum. This nuclear medicine procedure is important for diagnosing a congenital ileocecal appendage that can cause gastrointestinal bleeding, particularly in pediatric and young adult populations. Accurate coding affects clinical workflow, claims processing, and appropriate access to diagnostic imaging nationally.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 78290, typical settings where the service is delivered, and common billing considerations relevant to payers listed above. The publication also summarizes typical service duration and patient preparation, and points to where readers can find benchmarks and policy updates related to nuclear medicine imaging authorization and coverage criteria.
This summary is intended for a national audience of billing specialists, radiology and nuclear medicine departments, and policy analysts seeking a clear, practice‑focused description of CPT code 78290 and the practical implications for coverage and facility workflows.
Billing Code Overview
CPT code 78290 describes radionuclide intestinal imaging (Meckel's scan) to localize ectopic gastric mucosa within a Meckel's diverticulum. The procedure uses an intravenous radioisotope (commonly technetium‑99m pertechnetate) and a larger field–of–view gamma camera to detect focal uptake in ectopic gastric tissue. Patients are typically instructed to fast for at least four hours prior to the study. Imaging acquisition takes about 30 minutes, excluding pre‑imaging preparation and administrative formalities.
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Service type: Radionuclide imaging/scintigraphy for localization of Meckel's diverticulum
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Typical site of service: Outpatient imaging center or hospital nuclear medicine department
Clinical & Coding Specifications
Clinical Context
A typical patient is a child or adolescent presenting with painless, intermittent lower gastrointestinal bleeding or iron deficiency anemia where Meckel's diverticulum is suspected. The clinical workflow begins with outpatient evaluation by a pediatrician or pediatric gastroenterologist, including history, physical exam, and laboratory testing (CBC, stool guaiac). When scintigraphic localization is indicated, the patient is scheduled for an intestinal imaging (Meckel's) scan. The patient is instructed to fast for at least four hours prior to arrival. On arrival to the nuclear medicine department (typical site of service: outpatient imaging center, hospital radiology/nuclear medicine department), IV access is obtained and technetium-99m pertechnetate is administered. Imaging with a large field–of–view gamma camera takes approximately 30 minutes; pre- and post-imaging activities (consent, IV placement, possible premedication such as H2 blocker or glucagon per institutional protocol) add additional time. Images are interpreted by a nuclear medicine physician or radiologist with nuclear medicine training; results guide surgical referral for definitive management if a Meckel's diverticulum is localized, or further diagnostic evaluation if negative or equivocal.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation and report separate from technical imaging services. |