CT Indications & Patient Preparation
CPT
Exam
Contrast
Common Reasons For the Exam*
70450
none
headaches, injury, dizziness, gait disturbance
history of cancer with headaches, dizziness or
gait disturbance
previous abnormal imaging, question of
stenosis or aneurysm
Brain and skull
none
Brain, skull, and lesions/tumors
Clear liquids only 4hrs prior
70496
Head w/o contrast
Head w/o & with
contrast
CTA Head
(angiogram)
Arteries of the brain
Clear liquids only 4hrs prior
70486
Sinus w/o contrast
none
chronic sinusitis, headache
none
70486
Sinus Limited
none
chronic sinusitis, headache
70486
Facial Bones
Facial with
contrast
none
injury, pain
none
70487
Mandible Bone
Mandible with
contrast
pain, swelling, question cellulitis/mass
All facial sinuses
posterior frontal sinus/anterior maxillary
sinus
Superior to the frontal sinus through
maxilla
Superior to the frontal sinus through
maxilla
Superior to the condyle through the
mental process
Superior to the condyle through the
mental process
70480
Orbit Bones
none
injury, pain
Orbit bones only
none
70481
70491
70492
Orbit with contrast
IV
Orbit area only
Clear liquids only 4hrs prior
Soft Tissue Neck
IV**
pain, swelling, question cellulitis/mass
pain, swelling, mass (If looking for stones order
with and without)
Nasopharynx through thyroid gland
Clear liquids only 4hrs prior
71250
Chest w/o contrast
Chest with
contrast
Lung CA
Screening
High Resolution
Chest
CTA Chest
(angiogram)
none
pulmonary nodule
previous abnormal imaging, cancer, cough,
mediastinal abnormalities
Apices through adrenal glands
none
Apices through adrenal glands
Clear liquids only 4hrs prior
Lung cancer screening
Sarcoidosis, Bronchiectasis, Interstitial Lung
Disease
SOB, CP, question of PE or Thoracic Aortic
Dissection
Apices through adrenal glands
none
Apices to lung bases at 20mm interval
none
Pulmonary Artery or Thoracic Aorta
Clear liquids only 4hrs prior
70470
70487
70486
71260
71250
71250
71275
IV
IV
IV
IV
IV
none
none
IV
pain, swelling, question cellulitis/mass
injury, pain
Coverage Area
Patient Preparation
none
none
Clear liquids only 4hrs prior
none
Clear liquids only 4hrs prior
74150
AAA w/o contrast
74160
Abdomen
74175
CTA Abdomen
(angiogram)
74170
74150
72192
Kidney
74170
72194
Urogram without &
with contrast
74150
Adrenal Gland w/o
Adrenal Gland w/o
& with contrast
Pancreatic Mass
w/o & with
contrast
Liver w/o & with
contrast (dynamic
liver)
74170
74170
74170
72193
72191
75635
74160
72193
74160
72193
74160
72193
Helical Calculus
Survey
none
IV**
IV
IV***
none
IV
none
F/U AAA or abnormal previous imaging
question AAA with no pain
upper quadrant pain, cancer, elevated LFT's,
pancreatitis
Abdominal aorta
Superior to the liver/spleen to the aortic
bifurcation
pain question of dissecting aorta, looking for
mesenteric ischemia, renal artery stenosis
Superior to the liver/spleen through the
aortic bifurcation
Clear liquids only 4hrs prior
abnormal previous imaging, mass, cyst
Kidneys only
Clear liquids only 4hrs prior
Above the kidneys through the bladder
none
Above the liver/spleen through the
bladder
Clear liquids only 4hrs prior
Adrenal glands only
none
Adrenal glands only
Clear liquids only 4hrs prior
flank pain, hx kidney stones, hematuria only
looking for stones
pain, hematuria, abnormal previous imaging,
looking for kidney stones, kidney mass/bladder
mass, and urinary obstructions
CTA Run Off
Appendix scan
Diverticulitis scan
IV
IV
abnormal previous imaging, known pancreatic
mass
Pancreas only
Clear liquids only 4hrs prior
IV
abnormal previous imaging, liver lesion,
hemangioma
Liver only
Clear liquids only 4hrs prior
Clear liquids only 4hrs prior Patient must
pick up oral contrast a minimum of 2hrs
prior to scan
GI bleed, pre-op AAA
PVD, blue toes, lower extremity ischemia,
aneurysm
Superior to the pelvic crest through the
pubic bones
Superior to the pelvic crest through the
pubic bones
Abdominal/Pelvic/Lower extremity
arteries
pain with question of appendicitis
Superior to the liver/spleen through the
pubic bones
n/a as an emergent scan done with rectal
contrast
pain with question of diverticulitis
Superior to the liver/spleen through the
pubic bones
abd pain, hx crohns, question of crohns
Superior to the liver/spleen through the
pubic bones
Clear liquids only 4hrs prior done with
rectal contrast
Clear liquids only 4hrs prior. Patient must
come 1.5 hrs prior to scan to drink oral
contrast
lower quadrant pain, cancer
IV
IV
IV**
IV**
IV**
Enterography
Clear liquids only 4hrs prior
F/U known adenoma for assessment of size
abnormal previous imaging, mass, elevated
enzymes, high blood pressure
IV**
Pelvis
CTA Pelvis
(angiogram)
none
* Whether or not these meet medical necessity and/or insurance requirements depends on the individual patient and insurance carrier.
** IV contrast should always be used unless contraindicated.
*** Should always be done without and with contrast unless contraindicated.
Scheduling Phone: 603-598-3323
Clear liquids only 4hrs prior
Clear liquids only 4hrs prior