Summary & Overview
CPT 78811: Targeted PET Scan of a Localized Body Region
CPT code 78811 represents a targeted positron emission tomography (PET) scan performed on a small, defined area of the body. As a focused nuclear imaging study, this procedure provides three-dimensional functional images useful for detecting and characterizing tumor cells and localized metabolic activity. Nationally, PET imaging remains a critical tool in oncology diagnosis, staging, and treatment planning, and targeted PET studies like 78811 allow clinicians to concentrate resources on specific clinical questions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how this service is categorized, typical sites of service, and which payers commonly cover targeted PET procedures. The publication summarizes common modifiers associated with imaging claims and outlines areas where clinical context drives utilization.
This briefing delivers practical reference material: a concise clinical description of CPT code 78811, payer coverage context, and the types of benchmarks and policy topics readers can expect in the full publication, including reimbursement benchmarking, claim coding considerations, and clinical appropriateness factors. Data not available in the input is noted where relevant.
Billing Code Overview
CPT code 78811 describes a diagnostic positron emission tomography (PET) procedure focused on a small, defined area of the body. PET is a nuclear imaging modality that produces three-dimensional images of functional processes and is commonly used to detect and evaluate tumor cells and metabolic activity within a localized region.
Service Type: Targeted PET imaging of a localized body region
Typical Site of Service: Hospital outpatient imaging department, freestanding imaging center, or advanced nuclear medicine suite
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of non-small cell lung cancer and new focal pulmonary uptake on surveillance imaging is referred for a targeted PET scan of the chest. The nuclear medicine team schedules a positron emission tomography focused on a small, defined area to assess metabolic activity within a pulmonary nodule and evaluate for local recurrence or metastatic disease. Prior to the study, the patient receives radiotracer injection, has a period of uptake time, and then is positioned for imaging of the chest region only. The procedure is typically ordered by an oncology or thoracic surgery provider, performed in an outpatient imaging center or hospital nuclear medicine department, and includes image acquisition, processing, and interpretation by a radiologist or nuclear medicine physician. Results are reported to the referring clinician to guide staging, biopsy planning, or treatment decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing physician interpretation/separate professional component for the PET study |
TC | Technical component | When billing only the technical component (scanner, technologist, radiopharmaceutical) |