AI CPT Codes. x x MRI Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)

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1 Code Category Description Auth Required Medicaid Medicare 0126T IMT Testing Common carotid intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor assessment MRI Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) CT/CTA Computed tomography, head or brain; without contrast (s) CT/CTA Computed tomography, head or brain; with contrast (s) CT/CTA Computed tomography, head or brain; without contrast, followed by contrast (s) and further CT/CTA Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast CT/CTA Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast (s) CT/CTA Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast, followed by contrast (s) and further CT/CTA Computed tomography, maillofacial area; without contrast CT/CTA Computed tomography, maillofacial area; with contrast (s) CT/CTA Computed tomography, maillofacial area; without contrast, followed by contrast (s) and further CT/CTA Computed tomography, soft tissue neck; without contrast CT/CTA Computed tomography, soft tissue neck; without contrast CT/CTA Computed tomography, soft tissue neck; without contrast followed by contrast (s) and further CT/CTA Computed tomographic angiography, head, with contrast (s), including noncontrast images, if performed, and image postprocessing CT/CTA Computed tomographic angiography, neck, with contrast (s), including noncontrast images, if performed, and image postprocessing MRI Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) MRI Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast (s) MRI Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast (s), followed by contrast (s) and further sequences MRA Magnetic resonance angiography, head; without contrast (s) MRA Magnetic resonance angiography, head; with contrast 1

2 (s) MRA Magnetic resonance angiography, head; without contrast (s), followed by contrast (s) and further sequences MRA Magnetic resonance angiography, neck; without contrast (s) MRA Magnetic resonance angiography, neck; with contrast (s) MRA Magnetic resonance angiography, neck; without contrast (s), followed by contrast (s) and further sequences MRI Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast MRI Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast (s) MRI Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast, followed by contrast (s) and further sequences MRI Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration MRI Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing MRI (during intracranial procedure MRI (during intracranial procedure MRI (during intracranial procedure Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); with contrast (s) Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast (s), followed by contrast (s) and further sequences CT/CTA Computed tomography, thora; without contrast CT/CTA Computed tomography, thora; with contrast (s) CT/CTA Computed tomography, thora; without contrast, followed by contrast (s) and further CT/CTA Computed tomographic angiography, chest (noncoronary), with contrast (s), including noncontrast images, if performed, and image postprocessing MRI Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast (s) 2

3 71551 MRI Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast (s) MRI Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast (s), followed by contrast (s) and further sequences MRA Magnetic resonance angiography, chest (ecluding myocardium), with or without contrast (s) CT/CTA Computed tomography, cervical spine; without contrast CT/CTA Computed tomography, cervical spine; with contrast CT/CTA Computed tomography, cervical spine; without contrast, followed by contrast (s) and further CT/CTA Computed tomography, thoracic spine; without contrast CT/CTA Computed tomography, thoracic spine; with contrast CT/CTA Computed tomography, thoracic spine; without contrast, followed by contrast (s) and further CT/CTA Computed tomography, lumbar spine; without contrast CT/CTA Computed tomography, lumbar spine; with contrast CT/CTA Computed tomography, lumbar spine; without contrast, followed by contrast (s) and further MRI Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast MRI Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast (s) MRI Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast MRI Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast (s) MRI Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast MRI Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast (s) MRI Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast, followed by contrast (s) and further sequences; cervical MRI Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast, followed by contrast (s) and further sequences; thoracic MRI Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast, followed by contrast (s) and further sequences; lumbar

4 MRA Magnetic resonance angiography, spinal canal and contents, with or without contrast (s) CT/CTA Computed tomographic angiography, pelvis, with contrast (s), including noncontrast images, if performed, and image postprocessing CT/CTA Computed tomography, pelvis; without contrast CT/CTA Computed tomography, pelvis; with contrast (s) CT/CTA Computed tomography, pelvis; without contrast, followed by contrast (s) and further MRI Magnetic resonance (eg, proton) imaging, pelvis; without contrast (s) MRI Magnetic resonance (eg, proton) imaging, pelvis; with contrast (s) MRI Magnetic resonance (eg, proton) imaging, pelvis; without contrast (s), followed by contrast (s) and further sequences MRA Magnetic resonance angiography, pelvis, with or without contrast (s) CT/CTA Computed tomography, upper etremity; without contrast CT/CTA Computed tomography, upper etremity; with contrast (s) CT/CTA Computed tomography, upper etremity; without contrast, followed by contrast (s) and further CT/CTA Computed tomographic angiography, upper etremity, with contrast (s), including noncontrast images, if performed, and image postprocessing MRI Magnetic resonance (eg, proton) imaging, upper etremity, other than joint; without contrast (s) MRI Magnetic resonance (eg, proton) imaging, upper etremity, other than joint; with contrast (s) MRI Magnetic resonance (eg, proton) imaging, upper etremity, other than joint; without contrast (s), followed by contrast (s) and further sequences MRI Magnetic resonance (eg, proton) imaging, any joint of upper etremity; without contrast (s) MRI Magnetic resonance (eg, proton) imaging, any joint of upper etremity; with contrast (s) MRI Magnetic resonance (eg, proton) imaging, any joint of upper etremity; without contrast (s), followed by contrast (s) and further sequences MRA Magnetic resonance angiography, upper etremity, with or without contrast (s) CT/CTA Computed tomography, lower etremity; without contrast CT/CTA Computed tomography, lower etremity; with contrast (s) CT/CTA Computed tomography, lower etremity; without contrast, followed by contrast (s) and further

5 CT/CTA Computed tomographic angiography, lower etremity, with contrast (s), including noncontrast images, if performed, and image postprocessing MRI Magnetic resonance (eg, proton) imaging, lower etremity other than joint; without contrast (s) MRI Magnetic resonance (eg, proton) imaging, lower etremity other than joint; with contrast (s) MRI Magnetic resonance (eg, proton) imaging, lower etremity other than joint; without contrast (s), followed by contrast (s) and further sequences MRI Magnetic resonance (eg, proton) imaging, any joint of lower etremity; without contrast MRI Magnetic resonance (eg, proton) imaging, any joint of lower etremity; with contrast (s) MRI Magnetic resonance (eg, proton) imaging, any joint of lower etremity; without contrast (s), followed by contrast (s) and further sequences MRA Magnetic resonance angiography, lower etremity, with or without contrast (s) CT/CTA Computed tomography, abdomen; without contrast CT/CTA Computed tomography, abdomen; with contrast (s) CT/CTA Computed tomography, abdomen; without contrast, followed by contrast (s) and further CT/CTA Computed tomographic angiography, abdomen and pelvis, with contrast (s), including noncontrast images, if performed, and image postprocessing CT/CTA Computed tomographic angiography, abdomen, with contrast (s), including noncontrast images, if performed, and image postprocessing CT/CTA Computed tomography, abdomen and pelvis; without contrast CT/CTA Computed tomography, abdomen and pelvis; with contrast (s) CT/CTA Computed tomography, abdomen and pelvis; without contrast in 1 or both body regions, followed by contrast (s) and further in 1 or both body regions MRI Magnetic resonance (eg, proton) imaging, abdomen; without contrast (s) MRI Magnetic resonance (eg, proton) imaging, abdomen; with contrast (s) MRI Magnetic resonance (eg, proton) imaging, abdomen; without contrast (s), followed by with contrast (s) and further sequences MRA Magnetic resonance angiography, abdomen, with or without contrast (s)

6 74261 CT/CTA Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast CT/CTA Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast (s) including non-contrast images, if performed CT/CTA Computed tomographic (CT) colonography, screening, including image postprocessing MRI Cardiac magnetic resonance imaging for morphology and function without contrast ; MRI Cardiac magnetic resonance imaging for morphology and function without contrast ; with stress imaging MRI Cardiac magnetic resonance imaging for morphology and function without contrast (s), followed by contrast (s) and further sequences; MRI Cardiac magnetic resonance imaging for morphology and function without contrast (s), followed by contrast (s) and further sequences; with stress imaging MRI Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure) CT/CTA Computed tomography, heart, without contrast, with quantitative evaluation of coronary calcium CT/CTA and 3- D Imaging CT/CTA and 3- D Imaging CT/CTA and 3- D Imaging Computed tomography, heart, with contrast, 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, 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, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) CT/CTA Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower etremity runoff, with contrast (s), including noncontrast images, if performed, and image postprocessing CT/CTA and 3- D Imaging CT/CTA and 3- D Imaging 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image postprocessing on an independent workstation 6

7 76380 CT/CTA Computed tomography, limited or localized follow-up study SPECT Magnetic Resonance Spectroscopy CT/CTA Unlisted computed tomography procedure (eg, diagnostic, interventional) MRI Unlisted magnetic resonance procedure (eg, diagnostic, interventional) MRI Magnetic resonance imaging, breast, without and/or with contrast (s); unilateral MRI Magnetic resonance imaging, breast, without and/or with contrast (s); bilateral CT/CTA Computed tomography, bone mineral density study, 1 or more sites; aial skeleton (eg, hips, pelvis, spine) MRI Magnetic resonance (eg, proton) imaging, bone marrow blood supply SPECT PARATHYROID PLANAR IMAGING W/WO SUBTRACTION; with tomographic (SPECT) SPECT PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT SPECT Liver imaging (SPECT); SPECT Liver imaging (SPECT); with vascular flow SPECT Bone and/or joint imaging; tomographic (SPECT) Musculoskeletal Unlisted musculoskeletal procedure, diagnostic nuclear Eam medicine Cardiac Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without pharmacologic intervention or eercise, single or multiple Cardiac determinations Cardiac shunt detection SPECT 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 (eercise or pharmacologic) SPECT 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 (eercise or pharmacologic) and/or redistribution and/or rest reinjection Cardiac Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (eercise or pharmacologic) 7

8 78454 Cardiac Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (eercise or pharmacologic) and/or redistribution and/or rest reinjection PET Myocardial imaging, positron emission tomography (PET), metabolic evaluation Cardiac Myocardial imaging, infarct avid, planar; qualitative or quantitative Cardiac Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique SPECT Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification Cardiac Cardiac Cardiac Cardiac Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (eercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress (eercise and/or pharmacologic), with or without additional quantification Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (eercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (eercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification PET Myocardial imaging, positron emission tomography (PET), perfusion; single study at rest or stress PET Myocardial imaging, positron emission tomography (PET), perfusion; multiple studies at rest and/or stress SPECT Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing Cardiac Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (List separately in addition to code for primary procedure) SPECT Brain imaging, tomographic (SPECT) PET Brain imaging, positron emission tomography (PET); metabolic evaluation PET Brain imaging, positron emission tomography (PET); perfusion evaluation SPECT Cerebrospinal fluid flow, imaging (not including introduction of ); tomographic (SPECT)

9 78710 SPECT Kidney imaging morphology; tomographic (SPECT) Cardiac All related Thallium-injections for Cardiac-: Cardiac Cardiac All related Thallium-injections for Cardiac-: All related Thallium-injections for Cardiac-: SPECT Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); tomographic (SPECT) Cardiac All related Thallium-injections for Cardiac-: Cardiac Cardiac All related Thallium-injections for Cardiac-: All related Thallium-injections for Cardiac-: SPECT Radiopharmaceutical localization of inflammatory process; tomographic (SPECT) Cardiac All related Thallium-injections for Cardiac-: PET Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) PET Positron emission tomography (PET) imaging; skull base to mid-thigh PET Positron emission tomography (PET) imaging; whole body PET Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck) PET Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh PET Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body G0288 CT/CTA Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery S8042 MRI Magnetic resonance imaging (MRI), low field 9

10 C8900 MRA Magnetic resonance angiography with contrast, abdomen X X C8920 MRA Magnetic resonance angiography without contrast, abdomen X X The following codes for Thallium are used when doing Card. Study. if the basic study is approved which ever additional code is included is approved. The same holds true for the denial.not as stand-alone codes Cardiac Cardiac Cardiac Cardiac Cardiac Cardiac Cardiac Cardiac Cardiac All related Thallium-injections for Cardiac-: All related Thallium-injections for Cardiac-: All related Thallium-injections for Cardiac-: All related Thallium-injections for Cardiac-: All related Thallium-injections for Cardiac-: All related Thallium-injections for Cardiac-: All related Thallium-injections for Cardiac-: All related Thallium-injections for Cardiac-: All related Thallium-injections for Cardiac-: 10

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