Summary & Overview
CPT 78813: Whole-Body Positron Emission Tomography (PET)
CPT code 78813 represents a whole-body positron emission tomography (PET) diagnostic procedure, a nuclear imaging modality that maps physiological processes and is widely used in oncology for tumor detection, staging, and treatment monitoring. Nationally, this imaging code matters because PET studies inform critical clinical decisions for cancer care, influence downstream treatment pathways, and carry significant utilization and cost implications for commercial and public payers.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage and reimbursement landscapes across major payers, common billing practices, and clinical contexts in which whole-body PET is applied. The publication summarizes typical sites of service and service definitions, presents benchmark utilization and payment considerations where available, and highlights policy trends that affect prior authorization, medical necessity criteria, and site-of-service dynamics.
This report is intended for payers, providers, billing professionals, and policy analysts seeking a concise national-level briefing on CPT code 78813, its clinical role in imaging, and the administrative factors that commonly affect claim processing and coverage determinations.
Billing Code Overview
CPT code 78813 describes a whole-body positron emission tomography (PET) diagnostic study. PET is a type of nuclear imaging that produces three-dimensional images of functional processes within the body and is commonly used to detect and stage malignant tumors, evaluate treatment response, and identify metastatic disease.
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Service type: Diagnostic nuclear medicine imaging (whole-body PET)
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Typical site of service: Outpatient imaging centers, hospital outpatient departments, and specialty radiology or nuclear medicine facilities
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of non-small cell lung cancer presents for staging and assessment of suspected metastatic disease. The patient was referred by an oncologist following new bone pain and rising tumor markers. The nuclear medicine team coordinates the visit: verification of indication and allergies, review of recent chemotherapy and glucose level for FDG studies, IV placement for radiotracer injection, and a waiting uptake period before imaging. The PET whole-body acquisition covers skull base to mid-thigh (or whole-body when clinically indicated), with image reconstruction and interpretation by a board-certified nuclear medicine physician. Results are reported to the referring oncologist and the multidisciplinary tumor board to guide staging, treatment planning, and response assessment. Typical sites of service include hospital-based outpatient imaging centers, freestanding PET/CT centers, and hospital inpatient radiology departments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation/report for the PET study when technical component is billed separately. |
TC | Technical component |