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

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1 CPT CODE PROCEDURE DESCRIPTION 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

2 72127 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 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

3 74261 CT COLONGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; W/O CONTRAST CT COLONGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; W/ CONTRAST, INCLUDING W/O CONTRAST IF PERFORMED CT COLONGRAPHY, SCREENING INCLUDING IMAGE POSTPROCESSING CT HEART WITHOUT CONTRAST MATERIAL, WITH QUANTITATIVE EVALUATION OF CORONARY CALCIUM CT HEART; W/CONTRAST, FOR EVAL OF CARDIAC STRUCTURE AND MORPHOLOGY (INCLUDING 3D IMAGE POSTPROCESSING, ASSESMENT OF CARDIAC FUNCTION & EVAL OF VENOUS STRUCTURES, IF PERFORMED) CT HEART; W/CONTRAST, FOR EVAL OF CARDIAC STRUCTURE AND MORPHOLOGY IN THE SETTING OF CONGENTIAL HEART DISEASE (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF LV CARDIAC FUNCTION, RV STRUCTURE & FUNCTION & EVAL OF VENOUS STRUCTURES, IF PERFORMED) CT ANGIOGRAPHY, HEART, CORONARY ARTERIES & BYPASS GRAFTS (WHEN PRESENT), W/CONTRAST (INCLUDING 3D POSTPROCESSING INCLUDING EVAL OF CARDIAC STRUCTURE & MORPHOLOGY, ASSESSMENTO FO CARDIACT FUNCTION & EVAL OF VENOUS STRUCTURES, IF PERFORMED) UNLISTED COMPUTED TOMOGRAPHY PROCEDURE 0042T CEREBRAL PERFUSION ANALYSIS USING CT WITH CONTRAST MRA MRA HEAD W/O CONTRAST MRA HEAD W/ CONTRAST MRA HEAD W & W/O CONTRAST MRA NECK W/O CONTRAST MRA NECK W CONTRAST MRA NECK W & W/O CONTRAST

4 71555 MRA CHEST (EXC MYOCARDIUM) W/ OR W/O CONTRAST MRI 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 MRI BRAIN (INCLUDING BRAIN STEM) W/O CONTRAST MRI BRAIN (INCLUDING BRAIN STEM) W/ CONTRAST MRI BRAIN (INCLUDING BRAIN STEM) W/O CONTRAST, FOLLOWED BY W/ CONTRAST MRI CHEST W/O CONTRAST MRI CHEST W CONTRAST MRI CHEST W & 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 CERVICAL SPINE W/ & W/O CONTRAST MRI THORACIC SPINE W/ & W/O CONTRAST MRI LUMBAR SPINE W/ & W/O CONTRAST MRI PELVIS W/O CONTRAST

5 72196 MRI PELVIS W CONTRAST MRI PELVIS W & W/O CONTRAST MRI UPPER EXTREMITY OTHER THAN JOINT W/O CONTRAST MRI UPPER EXTREMITY OTHER THAN JOINT W/ CONTRAST MRI UPPER EXTREMITY OTHER THAN JOINT W/ & W/O 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; W/O CONTRAST MATERIAL(S) MRI, LOWER EXTREMITY OTHER THAN JOINT; W/CONTRAST MATERIAL(S) MRI, LOWER EXTREMITY OTHER THAN JOINT; W/O CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES MRI, ANY JOINT OF LOWER EXTREMITY; W/O CONTRAST MATERIAL(S) MRI, ANY JOINT OF LOWER EXTREMITY; W/ CONTRAST MATERIAL(S) MRI; ANY JOINT OF LOWER EXTREMITY; W/O CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES MRI ABDOMEN W/O CONTRAST MRI ABDOMEN W CONTRAST MRI ABDOMEN W & W/O CONTRAST MRI BREAST UNILATERAL W/ AND/OR W/O CONTRAST MRI BREAST BILATERAL W/ AND/OR W/O CONTRAST UNLISTED MRI PROCEDURE S8037 MRCP

6 S8042 MRI LOW FIELD NUCLEAR CARDIOLOGY SPECT (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITAVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); SINGLE STUDY, AT REST OR STRESS (EXERCISE OR PHARMACOLOGIC) SPECT (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITAVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIES, AT REST &/OR STRESS (EXERCISE OR PHARMACOLOGIC) &/OR REDISTRIBUTION &/OR REST REINJECTION CARDIAC BLOOD POOL IMAGING (PLANAR), FIRST PASS TECHNIQUE; SINGLE STUDY, AT REST OR W/STRESS (EXERCISE &/OR PHARMACOLOGIC), WALL MOTION STUDY PLUS EJECTION FRACTION, WITH OR W/O 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

7 78813 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); WHOLE BODY TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION; LIMITED AREA (EG CHEST, HEAD/NECK) TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION; SKULL BASE TO MID-THIGH TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION; WHOLE BODY G0219 G0235 G0252 S8085 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)

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