2016 CPT Radiology, ECHO, and PET Codes Requiring Review
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2016 CPT Radiology, ECHO, and PET Codes Requiring Review (Please Note: Group # and Default CPT "1" are for internal claims processing use only) Modality Body Part CT Head 1 70480 CT orbit, sella or posterior fossa; w/o contrast Default CPT "1" 1 CT Head 1 70481 CT orbit, sella or posterior fossa; with contrast 0 CT Head 1 70482 CT orbit, sella or posterior fossa; w/o contrast followed by contrast 0 CT Head 2 70486 CT maxillofacial area (sinus); w/o contrast 1 CT Head 2 70487 CT maxillofacial area (sinus); with contrast 0 CT Head 2 70488 CT maxillofacial area (sinus); w/o contrast followed by contrast 0 CT Head 3 70450 CT head or brain; w/o contrast 1 CT Head 3 70460 CT head or brain; with contrast 0 CT Head 3 70470 CT head or brain; w/o contrast followed by contrast 0 CT Neck 4 70490 CT soft tissue neck; w/o contrast 1 CT Neck 4 70491 CT soft tissue neck; with contrast 0 CT Neck 4 70492 CT soft tissue neck; w/o contrast followed by contrast 0 CT Chest 5 71250 CT thorax; w/o contrast (noncardiac) 1 CT Chest 5 71260 CT thorax; with contrast (noncardiac) 0 CT Chest 5 71270 CT thorax; w/o contrast followed by contrast (noncardiac) 0 CT Abdomen 6 74150 CT abdomen; w/o contrast 1 CT Abdomen 6 74160 CT abdomen; with contrast 0 CT Abdomen 6 74170 CT abdomen; w/o contrast followed by contrast 0 CT Pelvis 7 72192 CT pelvis; w/o contrast 1 CT Pelvis 7 72193 CT pelvis; with contrast 0 CT Pelvis 7 72194 CT pelvis; w/o contrast followed by contrast 0 CT Spine 8 72125 CT cervical spine; w/o contrast 1 CT Spine 8 72126 CT cervical spine; with contrast 0 CT Spine 8 72127 CT cervical spine; w/o contrast followed by contrast 0 CT Spine 9 72128 CT thoracic spine; w/o contrast 1 CT Spine 9 72129 CT thoracic spine; with contrast 0 CT Spine 9 72130 CT thoracic spine; w/o contrast followed by contrast 0 CT Spine 10 72131 CT lumbar spine; w/o contrast 1 CT Spine 10 72132 CT lumbar spine; with contrast 0 CT Spine 10 72133 CT lumbar spine; w/o contrast followed by contrast 0 CT Extremity 11 73200 CT upper extremity; w/o contrast 1 CT Extremity 11 73201 CT upper extremity; with contrast 0 CT Extremity 11 73202 CT upper extremity; w/o contrast followed by contrast 0 CT Extremity 12 73700 CT lower extremity; w/o contrast 1 CT Extremity 12 73701 CT lower extremity; with contrast 0 CT Extremity 12 73702 CT lower extremity; w/o contrast followed by contrast 0 MRI Head 13 70551 MRI brain; w/o contrast 1 MRI Head 13 70552 MRI brain; with contrast 0 MRI Head 13 70553 MRI brain; w/o contrast followed by contrast 0 MRI Extremity 14 73218 MRI upper extremity, other than joint w/o contrast 1 MRI Extremity 14 73219 MRI upper extremity, other than joint with contrast 0 MRI Extremity 14 73220 MRI upper extremity, other than joint w/o contrast followed by contrast 0 MRI Spine 15 72141 MRI cervical spine; w/o contrast 1 MRI Spine 15 72142 MRI cervical spine; with contrast 0 MRI Spine 15 72156 MRI cervical spine; w/o contrast followed by contrast 0 MRI Spine 16 72146 MRI thoracic spine; w/o contrast 1 MRI Spine 16 72147 MRI thoracic spine; with contrast 0 MRI Spine 16 72157 MRI thoracic spine; w/o contrast followed by contrast 0 MRI Spine 17 72148 MRI lumbar spine; w/o contrast 1 MRI Spine 17 72149 MRI lumbar spine; with contrast 0 MRI Spine 17 72158 MRI lumbar spine; w/o contrast followed by contrast 0 MRI Heart 18 75557 MRI Cardiac for morphology and function without contrast material; 1 MRI Heart 18 75559 MRI Cardiac for morphology and function without contrast material; with stress imaging 0 019102 (11-2015) Group # CPT Description MRI Heart 18 75561 MRI Heart 18 75563 NUC Card Heart 19 78451 Myocardial perfusion SPECT single study including qualitative or quantitative wall motion, ejection fraction by 1st pass or gated technique, rest or stress 0 NUC Card Heart 19 78452 Myocardial perfusion SPECT multiple studies including qualitative or quantitative wall motion, ejection fraction by 1st pass or gated technique, rest 1 NUC Card Heart 19 78453 NUC Card Heart 19 78454 Myocardial perfusion planar multiple studies including qualitative or quantitative wall motion, ejection fraction by 1st pass or gated technique, rest and/or stress 0 MRI Head 23 70540 MRI orbit, face and neck; w/o contrast 1 MRI Head 23 70542 MRI orbit, face and neck; with contrast Modality Body Part MRI Head 23 70543 MRI orbit, face and neck; w/o contrast followed by contrast MRI Head 24 70336 MRI temporomandibular joint(s) 1 MRI Chest 25 71550 MRI chest; w/o contrast 1 MRI Chest 25 71551 MRI chest; with contrast 0 MRI Chest 25 71552 MRI chest; w/o contrast followed by contrast 0 MRI Abdomen 26 74181 MRI abdomen; w/o contrast 1 MRI Abdomen 26 74182 MRI abdomen; with contrast 0 MRI Abdomen 26 74183 MRI abdomen; w/o contrast followed by contrast 0 MRI Pelvis 27 72195 MRI pelvis; w/o contrast 1 MRI Pelvis 27 72196 MRI pelvis; with contrast 0 MRI Pelvis 27 72197 MRI pelvis; w/o contrast followed by contrast 0 MRI Breast 29 77058 Effective Date 10/27/14 MRI pelvis; Unilateral 1 MRI Breast 29 77059 Effective Date 10/27/14 MRI pelvis; Bi lateral 0 MRI Other 30 77084 MRI bone marrow blood supply 1 MRA Head 31 70544 MRA head; w/o contrast 1 MRA Head 31 70545 MRA head; with contrast 0 MRA Head 31 70546 MRA head; w/o contrast followed by contrast 0 MRA Chest 32 71555 MRA chest; with or w/o contrast 1 MRA Abdomen 33 74185 MRA abdomen; with or w/o contrast 1 MRA Pelvis 34 72198 MRA pelvis; with or w/o contrast 1 MRA Extremity 35 73225 MRA upper extremity; with or w/o contrast 1 MRA Extremity 36 73725 MRA lower extremity; with or w/o contrast 1 MRA Spine 37 72159 MRA spinal canal and contents with or w/o contrast 1 CT Other 40 77078 CT bone mineral density study; axial skeleton 1 NUC Card Heart 44 78466 Planar, infarct avid; qualitative or quantitative 0 NUC Card Heart 44 78468 Planar, infarct avid; with ejection fraction by first pass technique 0 NUC Card Heart 44 78469 SPECT, infarct avid; with or w/o quantification 1 MRI Extremity 46 73718 MRI lower extremity, other than joint w/o contrast 0 MRI Extremity 46 73719 MRI lower extremity, other than joint w contrast 0 MRI Extremity 46 73720 MRI lower extremity, other than joint w/o contrast followed by contrast 0 MRI Extremity 46 73721 MRI lower extremity, any joint w/o contrast 1 MRI Extremity 46 73722 MRI lower extremity, any joint w contrast 0 MRI Extremity 46 73723 MRI lower extremity, any joint w/o contrast followed by contrast 0 MRI Extremity 47 73221 MRI upper extremity, any joint w/o contrast 1 MRI Extremity 47 73222 MRI upper extremity, any joint with contrast 0 019102 (11-2015) Group # MRI Cardiac for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; MRI Cardiac for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging Myocardial perfusion planar single study including qualitative or quantitative wall motion, ejection fraction by 1st pass or gated technique, rest or stress CPT 0 0 0 0 Description Default CPT "1" 0 MRI Extremity 47 73223 MRI upper extremity, any joint w/o contrast followed by contrast 0 CTA Head 72 70496 CTA head 1 CTA Neck 73 70498 CTA neck 1 MRA Neck 74 70547 MRA neck; w/o contrast 1 MRA Neck 74 70548 MRA neck; with contrast 0 MRA Neck 74 70549 MRA neck; w/o contrast followed by contrast 0 CTA Chest 75 71275 CTA chest (noncoronary) 1 CTA Pelvis 76 72191 CTA pelvis 1 CTA Extremity 77 73206 CTA upper extremity 1 CTA Extremity 78 73706 CTA lower extremity 1 CTA Abdomen 79 74175 CTA abdomen 1 CTA Abdomen 123 75635 CTA abdominal aorta & bilateral iliofemoral lower extremity runoff 1 CTA Abd/Pelvis 122 74174 CTA Abdomen & Pelvis 0 MRI Other 81 MR Spectroscopy 1 NUC Card Heart 82 76390 Effective Date 10/27/14 78472 1 NUC Card Heart 82 78473 Cardiac blood pool, gated equilibrium; planar, single study, wall motion plus ejection fraction Cardiac blood pool gated equilibrium; planar, multiple studies, wall motion study plus ejection fraction NUC Card Heart 82 78481 Cardiac blood pool first pass tech; single study, wall motion study plus ejection fraction 0 NUC Card Heart 82 78483 Cardiac blood pool first pass tech; multiple studies, wall motion study plus ejection fraction 0 NUC Card Heart 82 78494 Cardiac blood pool gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction 0 0 ECHOCARDIOGRAPHY CODES - EFFECTIVE 2/9/2013 WA&OR, EFFECTIVE 1/1/2015 ALASKA Group # Heart 93 CPT 93350 Description Transthoracic Stress Echo, complete Default CPT "1" 1 WA, OR Eff 2/9/2013 AK Eff 1/1/15 Stress Echo (SE) Stress Echo Heart Resting Trans Heart Modality Body Part Resting Trans Heart Resting Trans Heart Resting Trans Heart Resting Trans Heart 93 93351 Transthoracic Stress Echo, complete w cont EKG 0 WA, OR Eff 2/9/2013 AK Eff 1/1/15 Group # 94 CPT Description 93303 WA, OR Eff 2/9/2013 AK Eff Transthoracic Echo cardiac anomalies 1/1/15 Group # 94 CPT Description 93304 WA, OR AK Eff Transthoracic Echo cardiac anomalies, limited 1/115 94 Default CPT "1" 93306 0 Transthoracic Echo complete w color & spectral 0 Transthoracic Echo complete wo color & spectral 1 WA, OR Eff 2/9/2013 AK Eff 1/1/15 94 93307 WA, OR Eff 2/9/2013 AK Eff 1/1/15 94 Group # 019102 (11-2015) 93308 Transthoracic Echo limited WA, OR Eff 2/9/2013 AK Eff 1/1/15 CPT 0 Description Transesop h Heart ageal Transesop h Heart ageal Transesop h Heart ageal Transesop h Heart ageal Transesop h Heart ageal Transesop h Heart ageal 93312 95 WA, OR Eff 2/9/2013 AK Eff Transesophageal Echo 1/1/15 95 WA, OR Eff 2/9/2013 AK Eff Transesophageal Echo probe only 1/1/15 95 WA, OR Eff 2/9/2013 AK Eff Transesophageal Echo interpretation 1/1/15 95 WA, OR Eff 2/9/2013 AK Eff Transesophageal Echo congenital 1/1/15 95 WA, OR Eff 2/9/2013 AK Eff Transesophageal Echo congenital, probe only 1/1/15 95 WA, OR Eff 2/9/2013 AK Eff Transesophageal Echo congenital interpretation 1/1/15 1 93313 0 93314 0 93315 0 93316 0 93317 Group # CPT Description Heart 93320 Doppler Echo complete Heart 93321 Doppler Echo limited Heart Echo Add- Heart O 93325 93352 Doppler Echo flow velocity Echo contrast agent (SE only) group 93 CPT Description 0 Echo AddOn Codes (do not Echo AddOn Codes (do not Echo AddOn Codes (do not Group # PET Head 42 78608 PET brain, metabolic evaluation Default CPT "1" 1 PET Head 42 78609 PET brain, perfusion evaluation 0 CPT Description Group # PET Heart 71 78459 PET myocardial, metabolic evaluation 1 PET Heart 71 78491 PET myocardial, perfusion, single study 0 PET Heart 71 78492 PET myocardial, perfusion, multiple studies 0 CPT Description Group # PET Other Modality Body Part PET Other PET Other PET 78811 PET tumor imaging, limited CPT Description 84 78812 PET tumor imaging, skull to mid-thigh 84 78813 PET tumor imaging, whole body 1 Other 84 78814 PET tumor imaging with concurrent CT, limited 0 PET Other 84 78815 PET tumor imaging with concurrent CT, skull to mid-thigh 0 PET Other 84 78816 PET tumor imaging with concurrent CT, whole body 0 CT Other 85 74263 Eff Date 10/27/14 Computed Tomographic (CT) Colonagraphy, screening, including image postporcessing 1 CT Other 86 74261 eff Computed Tomographic (CT) Colonagraphy,diagnostic, including image postprocessing; Date 10/27/2014 without contrast material 1 CT Other 86 74262 Eff Date Computed Tomographic (CT) Colonagraphy,diagnostic, including image postprocessing; 10/27/2014 without contrast material(s) including non-contrast images, if performed 0 019102 (11-2015) 84 Group # 0 Default CPT "1" 0 MRI Head 88 70554 Eff Date 10/27/2014 Functional MRI brain not requiring physician or psychologist 1 MRI Head 88 70555 Eff Date 10/27/2014 Functional MRI brain requiring physician or psychologist 0 CT Heart 98 75571 Eff Computed Tomographic, heart, without contrast material, with quantitive evaluation of Date 10/27/2014 coronay calcium 1 CT Heart 99 75572 1 CT Heart 99 75573 Eff Computed Tomographic, heart, with contrast material, for evaluation of cardiac structure Date 10/27/2014 and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed) Eff Computed Tomographic, heart, with contrast material, for evaluation of cardiac structure Date 10/27/2014 and morphology in the setting of congenital hear disease (including 3D image 0 postprocessing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, is performed) CT Heart 100 75574 Eff Computed tomograhic angiograhy, heart, coronary arteries and bypass graft(when present), Date 10/27/2014 with contrast material, including 3D image postprocessing including evaluation of cardiac 1 structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) CT Abd/Pelvis 101 74176 CT Abdomen & Pelvis without contrast 1 CT Abd/Pelvis 101 74177 CT Abdomen & Pelvis with contrast 0 CT Lung 102 S8032 Low Dose CT Lung Cancer Screening (COMMERCIAL LOB) CT Abd/Pelvis 101 74178 CT Abdomen & Pelvis wo/w contrast 0 MRI Chest 109 G0297 Eff Date 12/13/2014 Low Dose CT Lung Cancer Screening 1 MRI Pelvis 121 74712 MRI Fetal 1 019102 (11-2015)
