PROCEDURE DESCRIPTION RADIOLOGY STUDIES

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1 CPT CODE PROCEDURE DESCRIPTION RADIOLOGY STUDIES CT SCANS: CT HEAD/BRAIN W/O CONTRAST CT HEAD/BRAIN W/ CONTRAST CT HEAD/BRAIN W/O & W/ CONTRAST CT ORBIT W/O CONTRAST CT ORBIT W/ CONTRAST CT ORBIT W/O & W/ CONTRAST CT MAXLLFCL W/O CONTRAST CT MAXLLFCL W/ CONTRAST CT MAXLLFCL W/O & W/ CONTRAST CT SOFT TISSUE NECK W/O CONTRAST CT SOFT TISSUE NECK W/ CONTRAST CT SOFT TISSUE NECK W/O & W/ CONTRAST CT ANGIOGRAPHY HEAD CT ANGIOGRAPHY NECK CT THORAX W/O CONTRAST CT THORAX W/ CONTRAST CT THORAX W/O & W/ CONTRAST CT ANGIOGRAPHY CHEST, NON-CORONARY CT C SPINE W/O CONTRAST CT C SPINE W/ CONTRAST CT C SPINE W/O & W/ CONTRAST CT T SPINE W/O CONTRAST CT T SPINE W/ CONTRAST CT T SPINE W/O & W/ CONTRAST CT L SPINE W/O CONTRAST CT L SPINE W/ CONTRAST CT L SPINE W/O & W/ CONTRAST CT PELVIS W/O CONTRAST CT PELVIS W/ CONTRAST CT PELVIS W/O & W/ CONTRAST CT UPPER EXTREMITY W/O CONTRAST CT UPPER EXTREMITY W/ CONTRAST CT UPPER EXTREMITY W/O & W/ CONTRAST CT LOWER EXTREMITY W/O CONTRAST CT LOWER EXTREMITY W/ CONTRAST

SOFT TISSUE NECK W/ CONTRAST 70492 CT SOFT TISSUE NECK W/O & W/ CONTRAST 70496 CT ANGIOGRAPHY HEAD 70498 CT ANGIOGRAPHY NECK 71250 CT THORAX W/O CONTRAST 71260 CT THORAX W/ CONTRAST 71270 CT THORAX

2 73702 CT LOWER EXTREMITY W/O & W/ CONTRAST CT ABDOMEN W/O CONTRAST CT ABDOMEN W/ CONTRAST CT ABDOMEN W/O & W/ CONTRAST CT ABDOMEN & PELVIS W/O CONTRAST CT ABDOMEN & PELVIS W/CONTRAST CT ABDOMEN & PELVIS W/O CONTRAST FOLLOWED BY W/ CONTRAST COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITHOUT CONTRAST MATERIAL COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITH CONTRAST MATERIAL(S) INCLUDING NON-CONTRAST IMAGES, IF PERFORMED COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, SCREENING, INCLUDING IMAGE POSTPROCESSING CT HEART WITHOUT CONTRAST MATERIAL, WITH QUANTITATIVE EVALUATION OF CORONARY CALCIUM COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY IN THE SETTING OF CONGENITAL HEART DISEASE (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF LV CARDIAC FUNCTION, RV STRUCTURE AND FUNCTION AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEART, CORONARY ARTERIES AND BYPASS GRAFTS (WHEN PRESENT), WITH CONTRAST MATERIAL, INCLUDING 3D IMAGE POSTPROCESSING (INCLUDING EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) UNLISTED COMPUTED TOMOGRAPHY PROCEDURE 0042T CEREBRAL PERFUSION ANALYSIS USING CT WITH CONTRAST (**only in the outpatient/office setting) S8032 LOW-DOSE COMPUTED TOMOGRAPHY FOR LUNG CANCER SCREENING MR SCANS: MRI TMJ MRI FACE, ORBIT, AND/OR NECK W/O CONTRAST MRI FACE, ORBIT, AND/OR NECK W/ CONTRAST MRI FACE, ORBIT, AND/OR NECK W & W/O CONTRAST MRA HEAD W/O CONTRAST MRA HEAD W/ CONTRAST MRA HEAD W & W/O CONTRAST

POSTPROCESSING; WITHOUT CONTRAST MATERIAL COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITH CONTRAST MATERIAL(S) INCLUDING NON-CONTRAST IMAGES, IF PERFORMED

3 70547 MRA NECK W/O CONTRAST MRA NECK W CONTRAST MRA NECK W & W/O CONTRAST MRI BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MRI BRAIN (INCLUDING BRAIN STEM); WITH CONTRAST MRI BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST, FOLLOWED BY WITH CONTRAST FUNCTIONAL MRI BRAIN BY TECH FUNCTIONAL MRI BRAIN BY PHYS/PSYCH MRI CHEST W/O CONTRAST MRI CHEST W CONTRAST MRI CHEST W & W/O CONTRAST MRA CHEST (EXC MYOCARDIUM) W/ OR W/O CONTRAST MRI CERVICAL SPINE W/O CONTRAST MRI CERVICAL SPINE W/ CONTRAST MRI THORACIC SPINE W/O CONTRAST MRI THORACIC SPINE W/ CONTRAST MRI LUMBAR SPINE W/O CONTRAST MRI LUMBAR SPINE W/ CONTRAST MRI C SPINE W/ & W/O CONTRAST MRI T SPINE W/ & W/O CONTRAST MRI L SPINE W/ & W/O CONTRAST MRI PELVIS W/O CONTRAST MRI PELVIS W CONTRAST MRI PELVIS W & W/O CONTRAST MRI UPPER EXTREMITY OTHER THAN JOINT, WITHOUT CONTRAST MRI UPPER EXTREMITY OTHER THAN JOINT, WITH CONTRAST MRI UPPER EXTREMITY OTHER THAN JOINT, WITH AND WITHOUT CONTRAST MRI UPPER EXTREMITY JOINT W/O CONTRAST MRI UPPER EXTREMITY JOINT W CONTRAST MRI UPPER EXTREMITY JOINT W & W/O CONTRAST MRI LOWER EXTREMITY OTHER THAN JOINT, WITHOUT CONTRAST MRI LOWER EXTREMITY OTHER THAN JOINT, WITH CONTRAST MRI LOWER EXTREMITY OTHER THAN JOINT, WITH AND WITHOUT CONTRAST MRI LOWER EXTREMITY JOINT W/O CONTRAST MRI LOWER EXTREMITY JOINT W CONTRAST MRI LOWER EXTREMITY JOINT W & W/O CONTRAST MRI ABDOMEN W/O CONTRAST MRI ABDOMEN W CONTRAST MRI ABDOMEN W & W/O CONTRAST

CHEST W CONTRAST 71552 MRI CHEST W & W/O CONTRAST 71555 MRA CHEST (EXC MYOCARDIUM) W/ OR W/O CONTRAST 72141 MRI CERVICAL SPINE W/O CONTRAST 72142 MRI CERVICAL SPINE W/ CONTRAST 72146 MRI THORACIC

4 77058 MRI BREAST UNILATERAL WITH AND/OR WITHOUT CONTRAST MRI BREAST BILATERAL WITH AND/OR WITHOUT CONTRAST S8037 MRCP S8042 MRI LOW FIELD NUCLEAR CARDIOLOGY SCANS: MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); SINGLE STUDY, AT REST OR STRESS (EXERCISE OR PHARMACOLOGIC) MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIES, AT REST AND/OR STRESS (EXERCISE OR PHARMACOLOGIC) AND/OR REDISTRIBUTION AND/OR REST REINJECTION CARDIAC BLOOD POOL IMAGING (PLANAR), FIRST PASS TECHNIQUE; SINGLE STUDY, AT REST OR WITH STRESS (EXERCISE AND/OR PHARMACOLOGIC), WALL MOTION STUDY PLUS EJECTION FRACTION, WITH OR WITHOUT QUANTIFICATION CARDIAC BLOOD POOL IMAGING, MULTI CARDIAC BLOOD POOL IMAGING, SPECT CARDIAC BLOOD POOL IMAGING, SINGLE AT REST PET SCANS: MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) METABOLIC EVAL MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; SINGLE STUDY AT REST OR STRESS MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; MULTIPLE STUDIES AT REST OR STRESS BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) METABOLIC EVALUATION BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION EVALUATION TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); LIMITED AREA (EG, CHEST, HEAD/NECK) TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); SKULL BASE TO MID-THIGH TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); WHOLE BODY ANATOMICAL LOCALIZATION; LIMITED AREA (EG CHEST, HEAD/NECK) ANATOMICAL LOCALIZATION; SKULL BASE TO MID-THIGH

PERFORMED); SINGLE STUDY, AT REST OR STRESS (EXERCISE OR PHARMACOLOGIC) MYOCARDIAL PERFORMED); MULTIPLE STUDIES, AT REST AND/OR STRESS (EXERCISE OR PHARMACOLOGIC) AND/OR REDISTRIBUTION AND/OR REST

5 78816 G0219 G0235 G0252 S8085 ANATOMICAL LOCALIZATION; WHOLE BODY PET IMAGING WHOLE BONE; MELANOMA FOR NON COVERED INDICATIONS PET IMAGING, ANY SITE NOT OTHERWISE SPECIFIED PET IMAGING, FULL AND PARTIAL-RING PET SCANNERS ONLY, FOR INITIAL DIAGNOSIS OF BREAST CANCER AND/OR SURGICAL PLANNING FOR BREAST CANCER (E.G. INITIAL STAGING OF AXILLARY LYMPH NODES) FLUORINE-18 FLUORODEOXYGLUCOSE (F-18 FDG) IMAGING USING DUAL-HEAD COINCIDENCE DETECTION SYSTEM (NON-DEDICATED PET SCAN)

CPT CODE PROCEDURE DESCRIPTION. CT Scans 70450 CT HEAD/BRAIN W/O CONTRAST 70460 CT HEAD/BRAIN W/ CONTRAST 70470 CT HEAD/BRAIN W/O & W/ CONTRAST

CPT CODE PROCEDURE DESCRIPTION CT Scans 70450 CT HEAD/BRAIN W/O CONTRAST 70460 CT HEAD/BRAIN W/ CONTRAST 70470 CT HEAD/BRAIN W/O & W/ CONTRAST 70480 CT ORBIT W/O CONTRAST 70481 CT ORBIT W/ CONTRAST 70482