Nuclear Medicine Billing Services

Nuclear medicine billing involves more than the scan itself. A study includes a radiopharmaceutical, which is billed on its own code, plus the imaging and the physician's interpretation. Some tests also include a stress test, which adds another service to track.

PET studies add payer rules on diagnoses and on when a scan is covered, and these rules can differ between Medicare, Medicare Advantage, and commercial plans. Records must also show the dose given. Westmont Revenue Partners connects nuclear medicine practices with vetted billing experts who understand radiopharmaceutical billing, scan coding, and professional versus technical claims, and who can support the full revenue cycle.

Who this is for

• Nuclear medicine physicians and radiologists who read nuclear studies
• Hospital-based nuclear medicine departments
• Freestanding PET and nuclear imaging centers
• Cardiology practices with in-house nuclear labs
• Groups that treat patients with radionuclide therapy

What gets billed

• Myocardial perfusion imaging
• Bone scans
• Thyroid imaging and uptake studies
• PET and PET/CT tumor imaging
• Radiopharmaceutical doses and tracers
• Radionuclide therapy for selected conditions
• Stress testing performed with cardiac studies
• Professional interpretation and reports
• Technical component for owned equipment
• Pre-visit consultations for therapy planning

Commonly billed codes

Code	Type	What it covers
78452	CPT	Heart muscle blood flow imaging by SPECT, multiple studies
78306	CPT	Whole-body bone imaging
78018	CPT	Whole-body imaging to look for spread of thyroid cancer
78814	CPT	PET with CT for a limited area
78815	CPT	PET with CT, skull base to mid-thigh
78816	CPT	PET with CT, whole body
79005	CPT	Radionuclide therapy given by mouth
A9500	HCPCS	Technetium-99m sestamibi tracer, per dose
A9552	HCPCS	Fluorine-18 FDG tracer for PET, per study dose
26	Modifier	Professional component only
TC	Modifier	Technical component only

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in nuclear medicine

Professional vs. technical component billing. Most nuclear imaging codes can be billed globally or split. A hospital typically bills the technical component and the physician bills the professional read with modifier 26. A freestanding center that owns the camera and reads its own studies may bill globally. Radiopharmaceuticals are billed with the appropriate supply code by whoever buys the dose, and rules differ by setting. Billers confirm who owns each part before charges post.

• Radiopharmaceutical billing. The tracer has its own code and units. Billers match the code and quantity to the dose actually given, and check payer rules on separate payment.
• PET coverage rules. Medicare and other payers set rules by cancer type and by purpose of the scan, such as initial versus subsequent treatment strategy. Billers check the national and local policies for each case.
• Choosing the right scan code. Limited area, skull base to mid-thigh, and whole-body PET carry different codes. Billers confirm the extent of the study from the report.
• Stress testing with cardiac studies. A cardiac stress test is a separate service with its own code and supervision rules. Billers coordinate with cardiology so both are billed once and correctly.
• Prior authorization. Many payers require approval for PET and cardiac nuclear studies. Billers track authorization numbers by code.
• Split billing between groups. In shared arrangements, the hospital, cardiology group, and radiology group all have claims. Billers keep contracts clear so no part is missed or duplicated.
• Therapy documentation. Radionuclide therapy needs detailed dose and safety records. Billers check that notes support the code and the diagnosis.

How Westmont can help

• Matching you with vetted billing experts experienced in nuclear medicine
• End-to-end revenue cycle support, from authorization to payment posting
• Denial management for PET coverage and radiopharmaceutical claims
• Credentialing and payer enrollment help
• Reports by study type, payer, and component

Frequently asked questions

How are radiopharmaceuticals billed in nuclear medicine?

They are generally billed with HCPCS supply codes, separate from the imaging code. The code and units depend on the tracer and dose. Some payers bundle the cost in certain settings. Check each payer's rules and make sure the quantity matches your drug log.

What is the difference between professional and technical billing for a nuclear scan?

The technical component covers the camera, technologist, and supplies. The professional component covers the physician's interpretation. In hospitals, these are billed by separate parties. In a freestanding practice that owns the equipment and reads the study, the claim may be global.

Does Medicare cover PET scans for all cancers?

Coverage depends on the cancer type and the reason for the scan. Medicare uses national and local policies, and requirements change. Check the current coverage policy and confirm diagnosis and documentation before billing PET claims.

Who bills the stress test in a cardiac nuclear study?

The stress test is a separate service from the imaging, and whoever supervises and interprets it bills for it. Arrangements vary between cardiology groups, hospitals, and imaging centers. Review your contracts so each part is billed only once.

Why was our PET claim denied?

Common causes are missing authorization, a diagnosis that does not match coverage rules, or the wrong scan code. Review the denial, compare it to the report and the payer policy, and appeal with supporting clinical notes where appropriate.

Related billing services

• Radiology Billing
• Imaging Center Billing
• Cardiology Billing
• Oncology Billing
• Radiation Oncology Billing