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    v1.0.30
    OpenPayerBilling CodesOther Diagnostic Nuclear Medicine ProceduresCPT cpt-78815-pet-ct-tumor-imaging-anatomical-localization
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    CPT 78815: PET/CT Tumor Imaging with Anatomical Localization

    Medicare pays $112 and commercial payers pay $2026 on average nationally for this procedure.

    CPT code 78815 describes a combined PET/CT tumor imaging study in which positron emission tomography and computed tomography data are fused to provide both metabolic information and precise anatomical localization; service type: diagnostic PET with concurrently acquired CT for attenuation correction and anatomical localization (combined PET/CT); typical site of service: outpatient imaging centers or hospital radiology departments performing oncologic staging and tumor assessment.

    For related coverage guidance, see recent payer policy updates: Vafseo (vadadustat) for anemia in CKD on dialysis, Metabolic Disorders - Cysteamine (Oral) Products for Individual and Family Plans, Kerendia (finerenone) — Coverage Criteria.

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    National Reimbursement Benchmarks

    Medicare’s mean allowed rate of $112.3 is far below the commercial average represented by BUCA’s mean of $2,026.20, underscoring a wide gulf between government reimbursement and typical commercial contracts for CPT 78815. This gap reflects fundamentally different pricing benchmarks: Medicare’s tightly clustered local rates (p25 $108, p50 $112, p75 $114) contrast with BUCA’s substantially higher central tendency (p50 $1,824.30) and broader spread across commercial payers.

    Measuring dispersion as P75 minus P25, Blue Cross Blue Shield shows one of the narrowest interquartile spreads at $1,310.30 (p75 $3,252.40 minus p25 $1,942.10), while UnitedHealth Group’s spread is $1,887.10 (p75 $2,150.60 minus p25 $263.90). Cigna’s IQR is $1,241.60, Aetna’s is $1,082.20, and BUCA’s IQR is $1,342.50; Medicare is the tightest with an IQR of $6.00. These differences highlight greater variability among commercial payers compared with Medicare.

    Table of contents

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 64-year-old male with a newly diagnosed pulmonary mass (diagnosis C34.90) is referred by his oncology team for staging and treatment planning. The clinical workflow begins with an order for a tumor PET/CT (CPT 78815) to evaluate metabolic activity and localize disease. On arrival to the outpatient imaging center, the patient is screened for contraindications, intravenous access is obtained, and blood glucose is checked. The radiology/nuclear medicine team administers the radiotracer (commonly FDG), allows an uptake period, and performs a PET acquisition with a concurrently acquired CT for attenuation correction and anatomic localization. The hybrid PET/CT images are reviewed by a nuclear medicine physician or diagnostic radiologist who documents lesion metabolic activity, standardized uptake values (SUV), and anatomic correlation for treatment planning. The final report is transmitted to the referring oncologist and incorporated into staging, biopsy targeting, radiation planning, or systemic therapy decisions. Typical sites of service include hospital-based outpatient imaging departments, freestanding imaging centers, and tertiary academic centers. Typical patients include people with suspected or known malignancies such as lung (C34.90), breast (C50.919), prostate (C61), colon (C18.9), or pancreatic (C25.9) cancer undergoing staging, restaging, or treatment response assessment.

    Related CPT Codes

    CPT Code

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2085R0202X
    2085N0700X
    207U00000X
    207QA0000X
    367H00000X
    311ZA0620X
    374J00000X
    332800000X

    Related ICD-10-CM Codes

    31 rows

    ICD-10-CM CodeDescription
    C16.9Malignant neoplasm of stomach, unspecified
    C18.9Malignant neoplasm of colon, unspecified
    C22.0Liver cell carcinoma
    C25.9Malignant neoplasm of pancreas, unspecified
    C34.11Malignant neoplasm of upper lobe, right bronchus or lung
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C43.9Malignant melanoma of skin, unspecified
    C50.912Malignant neoplasm of unspecified site of left female breast
    C50.919Malignant neoplasm of unspecified site of unspecified female breast
    C54.9Malignant neoplasm of corpus uteri, unspecified

    Showing 1–10 of 31

    Related Payer Policy Updates

    Specialty: Nephrology1 / 3

    10 rows

    PolicyPayerEffective Date
    Vafseo (vadadustat) for anemia in CKD on dialysisCigna2026-08-15
    Metabolic Disorders - Cysteamine (Oral) Products for Individual and Family PlansCigna2026-08-15
    Kerendia (finerenone) — Coverage CriteriaBlue Cross Blue Shield - Iowa2026-08-05
    Voyxact (sibeprenlimab-szsl) — Prior authorization / medical necessity for primary IgA nephropathyColorado Rocky Mountain Health Plans2026-08-01
    Oxlumo (lumasiran) and Rivfloza (nedosiran) — Coverage Criteria (Ohio)Colorado Rocky Mountain Health Plans2026-08-01
    Korsuva (difelikefalin) — Medical Benefit Drug Coverage Criteria (Ohio)Colorado Rocky Mountain Health Plans2026-08-01
    Complement Inhibitors - EmpaveliCigna2026-08-01
    Tolvaptan (Jynarque)Cigna2026-08-01
    Nephrology - Filspari (sparsentan) coverageCigna2026-08-01
    Rivfloza (nedosiran) prior authorization for PH1UnitedHealthcare2026-08-01

    Related Codes

    CPT-78800-PLANAR-NUCLEAR-MEDICINE-SINGLE-AREA-TUMOR-LOCALIZATION

    CPT 78800: Planar Nuclear Medicine Imaging, Single Area

    CPT-78801-MULTI-DAY-MULTI-AREA-NUCLEAR-MEDICINE-IMAGING

    CPT 78801: Multi-Day/Multi-Area Nuclear Medicine Tumor Localization

    CPT-78802-WHOLE-BODY-NUCLEAR-MEDICINE-IMAGING

    CPT 78802: Whole-Body Nuclear Medicine Imaging for Tumor/Inflammation Localization

    CPT-78803-SPECT-SINGLE-AREA-LOCALIZATION

    CPT 78803: Single-Day SPECT Tumor/Tracer Localization

    CPT-78804-MULTIDAY-WHOLE-BODY-NUCLEAR-IMAGING-GAMMA-TRACER

    CPT 78804: Whole-Body Nuclear Medicine Imaging, Multi-Day

    CPT-78808-RADIOTRACER-INJECTION-GAMMA-PROBE-LOCALIZATION

    CPT 78808: Radioguided Localization with Intravenous Radiotracer

    CPT-78811-TARGETED-PET-LOCALIZED-BODY-REGION

    CPT 78811: PET, limited area imaging

    CPT-78812-FDG-PET-BODY-IMAGING-FOR-ONCOLOGIC-EVALUATION

    CPT 78812: FDG PET Imaging for Detection of Malignant Tumors

    CPT-78813-WHOLE-BODY-PET

    CPT 78813: PET Whole Body Scan

    CPT-78814-PET-CT-TUMOR-LOCALIZATION-METABOLIC-EVALUATION

    CPT 78814: PET/CT Tumor Localization and Metabolic Imaging

    Showing 1–10 of 16

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Description
    Relationship to This Procedure
    78814Tumor imaging, PET with concurrently acquired CT for attenuation correction and anatomical localization; limited area (eg, chest, head/neck)Used for PET/CT examinations confined to a limited anatomical area instead of the procedure described by 78815
    78816Tumor imaging, PET with concurrently acquired CT for attenuation correction and anatomical localization; whole bodyUsed when whole-body imaging is performed; may be reported instead of or in addition depending on scan extent relative to 78815