Does code 78434 require pre-authorization?


For those payers that require pre-authorization for nuclear medicine procedures, then yes, 78434 probably does need pre-authorization. The payer’s website should give you a list of codes needing pre-authorization, or if you’ve had a denial because there was no pre-authorization, then you will know in the future to pre-authorize. Medicare does not, at present, require preauthorization for this code. However, when the Appropriate Use Criteria (AUC) program goes fully live, 78434 is one of those codes that must have a Clinical Decision Support Mechanism (CDSM) consult.


CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.