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AetnaAll Plans · Coverage · Medical Policy · Nuclear Medicine, Cardiology, Neurology +3 moreMedium impact

Single Photon Emission Computed Tomography (SPECT) (CPB 0376, reviewed 2026-05-28)

Effective date
Not stated in the notice
Identified
Aug 14, 2026

Summary

Aetna's Clinical Policy Bulletin 0376 sets the coverage rules for single photon emission computed tomography (SPECT). Non-cardiac SPECT is considered medically necessary for a list of indications, including osteomyelitis, distinguishing bone from soft tissue infection, pulmonary embolism by SPECT ventilation/perfusion scintigraphy, distinguishing Parkinson's disease from essential tremor using DaTSCAN, localization of abscesses, lymphoma and necrosis differentiation, neuroendocrine tumor diagnosis and staging, presurgical ictal detection of seizure focus in epilepsy in place of PET, and thyroid cancer iodine imaging. SPECT for coronary artery disease diagnosis and prognosis is considered medically necessary, except as outlined in the policy's exclusion criteria. SPECT for a list of other uses, including Alzheimer's disease and dementia, attention deficit/hyperactivity disorder, autism, schizophrenia, stroke, and absolute quantitation of myocardial blood flow, is considered experimental, investigational or unproven.

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What to do

Action · 5 steps
01Billing team: For non-cardiac SPECT, confirm the study matches an indication the policy lists as medically necessary before billing CPT 78071, 78072, 78803, 78830, 78831 or 78832, because these codes are covered when selection criteria are met.
02For cardiac SPECT (CPT 78451, 78452, 78453, 78454 and 78469), medical necessity follows the eviCore Healthcare Cardiac Imaging Clinical Guidelines.
03For SPECT-CT parathyroid imaging (CPT 78072), the policy requires an enlarged parathyroid gland, parathyroid hyperplasia or suspected parathyroid adenoma or carcinoma, and laboratory evidence of hyperparathyroidism (parathyroid hormone greater than 55 pg/ml and serum calcium greater than 10.2 mg/dL).
04Check whether precertification is required for each CPT code using the CPT code search tool, because the policy notes precertification may be required for select procedures.
05The policy lists SPECT uses that Aetna considers experimental, investigational or unproven, and it lists ICD-10 codes that are not covered for the indications it describes.

Codes mentioned

7807178072788037883078831788327845178452784537845478469A9584A9500C9176R50.9R56.1Z01.818Z12.2Z12.73G31.83Z13.6R91.8R52Q76.2

Original notice

Single Photon Emission Computed Tomography (SPECT) (CPB 0376, reviewed 2026-05-28)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesNuclear MedicineCardiologyNeurologyOncologyPulmonologyRadiologyCode 78071Code 78072Code 78803Code 78830Code 78831Code 78832Code 78451Code 78452Code 78453Code 78454Code 78469Code A9584Code A9500Code C9176Code R50.9Code R56.1Code Z01.818Code Z12.2Code Z12.73Code G31.83Code Z13.6Code R91.8Code R52Code Q76.2

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