Summary & Overview
CPT 78814: PET/CT Fusion for Tumor Localization and Metabolic Evaluation
CPT code 78814 represents a combined positron emission tomography and computed tomography (PET/CT) fusion scan used to localize tumors and assess their metabolic activity before starting active cancer treatment. Nationally, this code is important because PET/CT fusion influences oncology staging, treatment planning, and monitoring, and it is commonly billed in outpatient imaging settings and hospital radiology departments. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what CPT code 78814 covers clinically, where the service is typically delivered, and which carriers commonly reimburse the service. The publication summarizes typical application of PET/CT fusion in oncology, outlines common billing considerations tied to the service line, and highlights payer coverage patterns and policy language where available. Benchmarks and utilization context are provided to help billing managers and policy analysts understand national trends in the use of PET/CT fusion for tumor localization and metabolic assessment. Data not available in the input is identified explicitly.
Billing Code Overview
CPT code 78814 describes a combined positron emission tomography and computed tomography (PET/CT) fusion diagnostic procedure used to evaluate the location and metabolic activity of tumors or cancer prior to initiating active treatment. The procedure acquires PET images that show metabolic processes and CT images that provide anatomic detail; these are fused to create a single, more informative image for staging, treatment planning, and assessment of disease extent.
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Service type: Diagnostic imaging; PET/CT fusion study
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Typical site of service: Hospital outpatient imaging departments, freestanding diagnostic imaging centers, and outpatient radiology suites
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a recent biopsy-confirmed non-small cell lung carcinoma is referred for staging prior to initiation of systemic therapy. The oncology team orders a combined positron emission tomography and computed tomography study to evaluate primary tumor metabolic activity, identify regional nodal involvement, and detect distant metastatic disease. The patient presents to an outpatient imaging center where technologists screen for contraindications, obtain intravenous access for radiotracer administration, and document medications and blood glucose. After radiotracer uptake time, the nuclear medicine physician supervises imaging acquisition on a hybrid PET/CT scanner, including low-dose CT for attenuation correction and diagnostic-quality CT when indicated. Images are fused and interpreted by the nuclear medicine or radiology physician, who reports standardized uptake values, anatomic localization of hypermetabolic lesions, and compares with prior imaging. The report is routed to the referring medical oncologist and entered into the electronic medical record for treatment planning and authorization of therapies.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional Component | When billing only the physician interpretation portion of the PET/CT (technical component billed separately). |
TC |