Horizon Blue Cross Blue Shield of NJ Radiology Rules Bank
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- Ethel Francis
- 8 years ago
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1 Horizon Blue Cross Blue Shield of NJ Radiology Rules Bank * Rule added 05/30/13 Code Pay Code Do Not Pay Source Myelography, posterior fossa, radiological supervision and Fluoroscopy, up to one hour physician time Myelography, posterior fossa, radiological supervision and Fluoroscopy, more than one hour physician time Myelography, posterior fossa, radiological supervision and Myelography, posterior fossa, radiological supervision and Fluoroscopic guidance for needle placement Myelography, posterior fossa, radiological supervision and Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures Cisternography, positive contrast, radiological supervision and Fluoroscopy, up to one hour physician time Cisternography, positive contrast, radiological supervision and Fluoroscopy, more than one hour physician time Cisternography, positive contrast, radiological supervision and Cisternography, positive contrast, radiological supervision and Fluoroscopic guidance for needle placement Cisternography, positive contrast, radiological supervision and Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures X-ray, mandible; complete, min of 4 views X-ray, mandible, partial, < 4 views X-ray, mastoids, complete, min of 3 views per side X-ray, mastoids, < 3 views per side X-ray facial bones, complete, min of 3 views X-ray, facial bones, < 3 views 1
2 70170 Dacryocystography, nasolacrimal duct, radiological supervision and Fluoroscopy, up to one hour physician time Dacryocystography, nasolacrimal duct, radiological supervision and Fluoroscopy, more than one hour physician time Dacryocystography, nasolacrimal duct, radiological supervision and Dacryocystography, nasolacrimal duct, radiological supervision and Fluoroscopic guidance for needle placement Dacryocystography, nasolacrimal duct, radiological supervision and Radiopharmaceutical dacryocystography X-rays, sinuses, paranasal, complete min of 3 views X-ray, sinuses, paranasal, < 3 views Complete, min of 4 views X-ray, skull, < 4 views X-ray exam of teeth, single view X-ray exam of teeth, single view X-ray exam teeth; complete full mouth X-ray exam of teeth, single view CPT Definition X-ray exam teeth; complete full mouth X-ray exam of teeth, single view CPT Definition X-ray TMJ, bilateral X-ray TMJ, unilateral TMJ arthrography, radiological supervision and Fluoroscopy, up to one hour physician time TMJ arthrography, radiological supervision and Fluoroscopy, more than one hour physician time TMJ arthrography, radiological supervision and
3 70332 TMJ arthrography, radiological supervision and Fluoroscopic guidance for needle placement MRI, TMJ TMJ arthrography, radiological supervision and CPT Definition Panoramic X-ray of Jaws X-ray exam of teeth, single view Panoramic X-ray of Jaws X-ray exam of teeth, single view Panoramic X-ray of Jaws X-ray exam teeth; complete full mouth Pharynx or larynx, including fluoro and/or magnification technique X-ray, neck, soft tissue Pharynx or larynx, including fluoro and/or magnification technique X-ray, pharynx and/or cervical esophagus Pharynx or larynx, including fluoro and/or magnification technique Swallowing function W cineradiography /videoradiography Pharynx or larynx, including fluoro and/or magnification technique Fluoroscopy, up to one hour physician time Pharynx or larynx, including fluoro and/or magnification technique Fluoroscopy, more than one hour physician time Pharynx or larynx, including fluoro and/or magnification technique Complex dynamic pharyngeal and speech evaluation by cine or video recording Pharynx or larynx, including fluoro and/or magnification technique Complex dynamic pharyngeal and speech evaluation by cine or video recording X-ray, pharynx and/or cervical esophagus Complex dynamic pharyngeal and speech evaluation by cine or video recording Swallowing function W cineradiography /videoradiography 3
4 70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording X-ray GI tract, upper, W or WO delayed films, WO KUB CPT Definition Complex dynamic pharyngeal and speech evaluation by cine or video recording Fluoroscopy, up to one hour physician time Complex dynamic pharyngeal and speech evaluation by cine or video recording Fluoroscopy, more than one hour physician time Complex dynamic pharyngeal and speech evaluation by cine or video recording Laryngography, contrast, radiological supervision and Fluoroscopy, up to one hour physician time Laryngography, contrast, radiological supervision and Fluoroscopy, more than one hour physician time Laryngography, contrast, radiological supervision and Sialography, radiological supervision and Fluoroscopy, up to one hour physician time Sialography, radiological supervision and Fluoroscopy, more than one hour physician time Sialography, radiological supervision and Sialography, radiological supervision and Fluoroscopic guidance for needle placement CT head WO contrast CT orbit WO contrast CT head WO contrast CT orbit W contrast CT head WO contrast CT orbit WO & W contrast 4
5 70450 CT head WO contrast CT limited or localized follow-up study CT Head W contrast CT head WO contrast CT Head W contrast CT orbit WO contrast CT Head W contrast CT orbit W contrast CT Head W contrast CT orbit WO & W contrast CT Head W contrast Fluoroscopy, up to one hour physician time CT Head W contrast Fluoroscopy, more than one hour physician time CT Head W contrast CT limited or localized follow-up study CT Head W contrast CT Head W contrast US guidance intra-operative CT Head W contrast CT Head W contrast Fluoroscopic guidance for needle placement CT head WO & W contrast CT head WO contrast CT head WO & W contrast CT head W contrast 5
6 70470 CT head WO & W contrast CT orbit WO contrast CT head WO & W contrast CT orbit W contrast CT head WO & W contrast CT orbit WO & W contrast CT head WO & W contrast Fluoroscopy, up to one hour physician time CT head WO & W contrast Fluoroscopy, more than one hour physician time CT head WO & W contrast CT limited or localized follow-up study CT head WO & W contrast CT head WO & W contrast US guidance intra-operative CT head WO & W contrast CT head WO & W contrast Fluoroscopic guidance for needle placement CT orbit,sella, posterior fossa, outer, middle or inner ear, WO contrast MRI orbit, face, neck, W contrast CPT Definition CT orbit,sella, posterior fossa, outer, middle or inner ear, WO contrast MRI face, orbit, face, WO & W contrast CPT Definition CT orbit,sella, posterior fossa, outer, middle or inner ear, WO contrast CT limited or localized follow-up study CT orbit, sella, W contrast CT orbit,sella, posterior fossa, outer, middle or inner ear, WO contrast 6
7 70481 CT orbit, sella, W contrast MRI orbit, face, neck, WO contrast CPT Definition CT orbit, sella, W contrast MRI orbit, face, neck, W contrast CPT Definition CT orbit, sella, W contrast MRI face, orbit, face, WO & W contrast CPT Definition CT orbit, sella, W contrast Fluoroscopy, up to one hour physician time CT orbit, sella, W contrast Fluoroscopy, more than one hour physician time CT orbit, sella, W contrast CT limited or localized follow-up study CT orbit, sella, W contrast CT orbit, sella, W contrast US guidance intra-operative CT orbit, sella, W contrast CT orbit, sella, W contrast Fluoroscopic guidance for needle placement CT orbit WO & W contrast CT orbit WO contrast CT orbit WO & W contrast CT orbit W contrast CT orbit WO & W contrast MRI orbit, face, neck, WO contrast CPT Definition CT orbit WO & W contrast MRI orbit, face, neck, W contrast CPT Definition 7
8 70482 CT orbit WO & W contrast MRI face, orbit, face, WO & W contrast CPT Definition CT orbit WO & W contrast Fluoroscopy, up to one hour physician time CT orbit WO & W contrast Fluoroscopy, more than one hour physician time CT orbit WO & W contrast CT limited or localized follow-up study CT orbit WO & W contrast CT orbit WO & W contrast US guidance intra-operative CT orbit WO & W contrast CT orbit WO & W contrast Fluoroscopic guidance for needle placement CT maxillofacial WO contrast CT limited or localized follow-up study CT maxillofacial W contrast CT maxillofacial area, WO contrast CT maxillofacial W contrast Fluoroscopy, up to one hour physician time CT maxillofacial W contrast Fluoroscopy, more than one hour physician time CT maxillofacial W contrast CT limited or localized follow-up study CT maxillofacial W contrast
9 70487 CT maxillofacial W contrast US guidance intra-operative CT maxillofacial W contrast CT maxillofacial W contrast Fluoroscopic guidance for needle placement CT maxillofacial WO & W contrast CT maxillofacial area, WO contrast CT maxillofacial WO & W contrast CT maxillofacial area, W contrast CT maxillofacial WO & W contrast Fluoroscopy, up to one hour physician time CT maxillofacial WO & W contrast Fluoroscopy, more than one hour physician time CT maxillofacial WO & W contrast CT limited or localized follow-up study CT maxillofacial WO & W contrast CT maxillofacial WO & W contrast US guidance intra-operative CT maxillofacial WO & W contrast CT maxillofacial WO & W contrast Fluoroscopic guidance for needle placement CT soft tissue neck, WO contrast MRI orbit, face, neck, WO contrast CPT Definition CT soft tissue neck, WO contrast MRI orbit, face, neck, W contrast CPT Definition 9
10 70490 CT soft tissue neck, WO contrast MRI face, orbit, face, WO & W contrast CPT Definition CT soft tissue neck, WO contrast CT limited or localized follow-up study CT soft tissue neck, WO contrast Parathyroid planar imaging; * CT soft tissue, neck, W contrast CT soft tissue neck WO contrast CT soft tissue, neck, W contrast MRI orbit, face, neck, WO contrast CPT Definition CT soft tissue, neck, W contrast MRI orbit, face, neck, W contrast CPT Definition CT soft tissue, neck, W contrast MRI face, orbit, face, WO & W contrast CPT Definition CT soft tissue, neck, W contrast Fluoroscopy, up to one hour physician time CT soft tissue, neck, W contrast Fluoroscopy, more than one hour physician time CT soft tissue, neck, W contrast CT limited or localized follow-up study CT soft tissue, neck, W contrast CT soft tissue, neck, W contrast CT soft tissue, neck, W contrast Fluoroscopic guidance for needle placement CT soft tissue, neck, W contrast Parathyroid planar imaging; * 10
11 70492 CT soft tissue, neck, WO & W contrast CT soft tissue neck WO contrast CT soft tissue, neck, WO & W contrast CT soft tissue, neck W contrast CT soft tissue, neck, WO & W contrast MRI orbit, face, neck, WO contrast CPT Definition CT soft tissue, neck, WO & W contrast MRI orbit, face, neck, W contrast CPT Definition CT soft tissue, neck, WO & W contrast MRI face, orbit, face, WO & W contrast CPT Definition CT soft tissue, neck, WO & W contrast Fluoroscopy, up to one hour physician time CT soft tissue, neck, WO & W contrast Fluoroscopy, more than one hour physician time CT soft tissue, neck, WO & W contrast CT limited or localized follow-up study CT soft tissue, neck, WO & W contrast CT soft tissue, neck, WO & W contrast US guidance intra-operative CT soft tissue, neck, WO & W contrast CT soft tissue, neck, WO & W contrast Fluoroscopic guidance for needle placement CT soft tissue, neck, WO & W contrast Parathyroid planar imaging; * CTA head W contrast, including noncontrast images, if performed, and image postprocessing CT head WO contrast 11
12 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing CT head W contrast CTA head W contrast, including noncontrast images, if performed, and image postprocessing CT head WO & W contrast CTA head W contrast, including noncontrast images, if performed, and image postprocessing Fluoroscopy, up to one hour physician time CTA head W contrast, including noncontrast images, if performed, and image postprocessing Fluoroscopy, more than one hour physician time CTA head W contrast, including noncontrast images, if performed, and image postprocessing D Rendering WO Postprocessing CTA head W contrast, including noncontrast images, if performed, and image postprocessing D Rendering W Postprocessing CTA head W contrast, including noncontrast images, if performed, and image postprocessing CT limited or localized follow-up study CTA head W contrast, including noncontrast images, if performed, and image postprocessing CTA head W contrast, including noncontrast images, if performed, and image postprocessing US guidance intra-operative CTA head W contrast, including noncontrast images, if performed, and image postprocessing CTA head W contrast, including noncontrast images, if performed, and image postprocessing Fluoroscopic guidance for needle placement CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CT soft tissue neck WO contrast CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CT soft tissue, neck W contrast CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CT soft tissue neck WO & W contrast 12
13 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing Fluoroscopy, up to one hour physician time CTA neck W contrast, including noncontrast images, if performed, and image postprocessing Fluoroscopy, more than one hour physician time CTA neck W contrast, including noncontrast images, if performed, and image postprocessing D Rendering WO Postprocessing CTA neck W contrast, including noncontrast images, if performed, and image postprocessing D Rendering W Postprocessing CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CT limited or localized follow-up study CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CTA neck W contrast, including noncontrast images, if performed, and image postprocessing US guidance intra-operative CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CTA neck W contrast, including noncontrast images, if performed, and image postprocessing Fluoroscopic guidance for needle placement MRI orbit, face and/or neck WO contrast MRA neck WO contrast MRI orbit, face and/or neck WO contrast MRA neck W contrast MRI orbit, face and/or neck, W contrast MRI orbit, face, neck, WO contrast MRI orbit, face and/or neck, W contrast Fluoroscopy, up to one hour physician time MRI orbit, face and/or neck, W contrast Fluoroscopy, more than one hour physician time 13
14 70542 MRI orbit, face and/or neck, W contrast MRI orbit, face and/or neck, W contrast US guidance intra-operative MRI orbit, face and/or neck, W contrast MRI orbit, face and/or neck, W contrast Fluoroscopic guidance for needle placement MRI orbit, face and/or neck, WO & W contrast MRI orbit, face, neck, WO contrast MRI orbit, face and/or neck, WO & W contrast MRI orbit, face, neck, W contrast MRI orbit, face and/or neck, WO & W contrast Fluoroscopy, up to one hour physician time MRI orbit, face and/or neck, WO & W contrast Fluoroscopy, more than one hour physician time MRI orbit, face and/or neck, WO & W contrast MRI orbit, face and/or neck, WO & W contrast US guidance intra-operative MRI orbit, face and/or neck, WO & W contrast MRI orbit, face and/or neck, WO & W contrast Fluoroscopic guidance for needle placement MRA, head WO contrast CTA head CPT Definition MRA, head WO contrast D Rendering WO Postprocessing 14
15 70544 MRA, head WO contrast D Rendering W Postprocessing MRA, head W contrast CTA head CPT Definition MRA, head W contrast MRA head, WO contrast MRA, head W contrast Fluoroscopy, up to one hour physician time MRA, head W contrast Fluoroscopy, more than one hour physician time MRA, head W contrast D Rendering WO Postprocessing MRA, head W contrast D Rendering W Postprocessing MRA, head W contrast MRA, head W contrast US guidance intra-operative MRA, head W contrast MRA, head W contrast Fluoroscopic guidance for needle placement MRA, head WO & W contrast CTA head CPT Definition MRA, head WO & W contrast MRA head, WO contrast MRA, head WO & W contrast MRA head, W contrast 15
16 70546 MRA, head WO & W contrast Fluoroscopy, up to one hour physician time MRA, head WO & W contrast Fluoroscopy, more than one hour physician time MRA, head WO & W contrast D Rendering WO Postprocessing MRA, head WO & W contrast D Rendering W Postprocessing MRA, head WO & W contrast MRA, head WO & W contrast US guidance intra-operative MRA, head WO & W contrast MRA, head WO & W contrast Fluoroscopic guidance for needle placement MRA, neck WO contrast CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CPT Definition MRA, neck WO contrast Fluoroscopy, up to one hour physician time MRA, neck WO contrast Fluoroscopy, more than one hour physician time MRA, neck WO contrast D Rendering WO Postprocessing MRA, neck WO contrast D Rendering W Postprocessing MRA, neck WO contrast
17 70547 MRA, neck WO contrast US guidance intra-operative MRA, neck WO contrast MRA, neck WO contrast Fluoroscopic guidance for needle placement MRA neck W contrast CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CPT Definition MRA neck W contrast MRA neck WO contrast MRA neck W contrast Fluoroscopy, up to one hour physician time MRA neck W contrast Fluoroscopy, more than one hour physician time MRA neck W contrast D Rendering WO Postprocessing MRA neck W contrast D Rendering W Postprocessing MRA neck W contrast MRA neck W contrast US guidance intra-operative MRA neck W contrast MRA neck W contrast Fluoroscopic guidance for needle placement MRA neck WO & W contrast CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CPT Definition 17
18 70549 MRA neck WO & W contrast MRA neck WO contrast MRA neck WO & W contrast MRA neck W contrast MRA neck WO & W contrast Fluoroscopy, up to one hour physician time MRA neck WO & W contrast Fluoroscopy, more than one hour physician time MRA neck WO & W contrast D Rendering WO Postprocessing MRA neck WO & W contrast D Rendering W Postprocessing MRA neck WO & W contrast MRA neck WO & W contrast US guidance intra-operative MRA neck WO & W contrast MRA neck WO & W contrast Fluoroscopic guidance for needle placement MRI brain WO contrast MRI brain, functional, W neuro functioning test by physician or psychologist MRI brain WO contrast MRI brain, during open intracranial procedure; WO contrast MRI brain WO contrast MRI brain WO contrast MRI brain W contrast MRI brain, functional, WO neuro functioning test by physician or psychologist 18
19 70552 MRI brain W contrast MRI brain, functional, W neuro functioning test by physician or psychologist MRI brain W contrast Fluoroscopy, up to one hour physician time MRI brain W contrast Fluoroscopy, more than one hour physician time MRI brain W contrast MRI brain W contrast US guidance intra-operative MRI brain W contrast MRI brain W contrast Fluoroscopic guidance for needle placement MRI brain WO & W contrast MRI brain WO contrast MRI brain WO & W contrast MRI brain W contrast MRI brain WO & W contrast MRI brain, functional, WO neuro functioning test by physician or psychologist MRI brain WO & W contrast MRI brain, functional, W neuro functioning test by physician or psychologist MRI brain WO & W contrast Fluoroscopy, up to one hour physician time MRI brain WO & W contrast Fluoroscopy, more than one hour physician time MRI brain WO & W contrast
20 70553 MRI brain WO & W contrast US guidance intra-operative MRI brain WO & W contrast MRI brain WO & W contrast Fluoroscopic guidance for needle placement MRI brain, functional, WO neuro functioning test by physician or psychologist MRI brain WO contrast MRI brain, functional, WO neuro functioning test by physician or psychologist MRI brain, during open intracranial procedure; WO contrast MRI brain, functional, WO neuro functioning test by physician or psychologist MRI brain, during open intracranial procedure; W contrast MRI brain, functional, WO neuro functioning test by physician or psychologist MRI brain, during open intracranial procedure; WO & W contrast MRI brain, functional, W neuro functioning test by physician or psychologist MRI brain, functional, WO neuro functioning test by physician or psychologist MRI brain, functional, W neuro functioning test by physician or psychologist MRI brain, during open intracranial procedure; WO contrast MRI brain, functional, W neuro functioning test by physician or psychologist MRI brain, during open intracranial procedure; W contrast MRI brain, functional, W neuro functioning test by physician or psychologist MRI brain, during open intracranial procedure; WO & W contrast MRI brain, during open intracranial procedure; WO contrast MRA head, WO contrast MRI brain, during open intracranial procedure; WO contrast MRA head, W contrast MRI brain, during open intracranial procedure; WO contrast MRA head WO & W contrast 20
21 70557 MRI brain, during open intracranial procedure; WO contrast MRI brain W contrast MRI brain, during open intracranial procedure; WO contrast MRI brain WO & W contrast MRI brain, during open intracranial procedure; WO contrast MR guidance for needle placement radiological supervision and MRI brain, during open intracranial procedure; W contrast MRA head, WO contrast MRI brain, during open intracranial procedure; W contrast MRA head, W contrast MRI brain, during open intracranial procedure; W contrast MRA head WO & W contrast MRI brain, during open intracranial procedure; W contrast MRI brain WO contrast MRI brain, during open intracranial procedure; W contrast MRI brain W contrast MRI brain, during open intracranial procedure; W contrast MRI brain WO & W contrast MRI brain, during open intracranial procedure; W contrast MRI brain, during open intracranial procedure; WO contrast MRI brain, during open intracranial procedure; W contrast Fluoroscopy, up to one hour physician time MRI brain, during open intracranial procedure; W contrast Fluoroscopy, more than one hour physician time MRI brain, during open intracranial procedure; W contrast MRI brain, during open intracranial procedure; W contrast
22 70558 MRI brain, during open intracranial procedure; W contrast Fluoroscopic guidance for needle placement MRI brain, during open intracranial procedure; W contrast MR guidance for needle placement radiological supervision and MRI brain, during open intracranial procedure; WO & W contrast MRA head, WO contrast MRI brain, during open intracranial procedure; WO & W contrast MRA head, W contrast MRI brain, during open intracranial procedure; WO & W contrast MRA head WO & W contrast MRI brain, during open intracranial procedure; WO & W contrast MRI brain WO contrast MRI brain, during open intracranial procedure; WO & W contrast MRI brain W contrast MRI brain, during open intracranial procedure; WO & W contrast MRI brain WO & W contrast MRI brain, during open intracranial procedure; WO & W contrast MRI brain, during open intracranial procedure; WO contrast MRI brain, during open intracranial procedure; WO & W contrast MRI brain, during open intracranial procedure; W contrast MRI brain, during open intracranial procedure; WO & W contrast Fluoroscopy, up to one hour physician time MRI brain, during open intracranial procedure; WO & W contrast Fluoroscopy, more than one hour physician time MRI brain, during open intracranial procedure; WO & W contrast MRI brain, during open intracranial procedure; WO & W contrast
23 70559 MRI brain, during open intracranial procedure; WO & W contrast Fluoroscopic guidance for needle placement MRI brain, during open intracranial procedure; WO & W contrast MR guidance for needle placement radiological supervision and X-ray, chest; single view, frontal X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections X-ray, chest; single view, frontal X-ray, chest, 2 views, front and lateral; fluoroscopy X-ray, chest; single view, frontal X-ray, chest, complete min 4 views X-ray, chest; single view, frontal X-ray, chest, complete min 4 views, Fluoroscopy X-ray, chest; single view, frontal 0175T CAD Including Computer Algorithm Analysis Of Digital Image Data For Lesion Detection, W Further Physician Review For Interpretation And Report, W or WO Digitization Of Film Radiographic Images, Chest Radiograph(S) Performed remote from primary viewing X-ray, chest; single view, stereo, frontal X-ray, chest; single view, frontal X-ray, chest; single view, stereo, frontal X-ray, chest ; 2 views, front and lateral X-ray, chest; single view, stereo, frontal X-ray, chest, 2 views, front and lateral; fluoroscopy X-ray, chest ; 2 views, front and lateral X-ray, chest ; 2 views, front and lateral X-ray, chest ; 2 views, front and lateral X-ray, chest, 2 views, front and lateral; W apical lordotic procedure X-ray, chest ; 2 views, front and lateral X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections X-ray, chest ; 2 views, front and lateral X-ray, chest, 2 views, front and lateral; fluoroscopy 23
24 71020 X-ray, chest ; 2 views, front and lateral X-ray, chest, complete min 4 views X-ray, chest ; 2 views, front and lateral X-ray, chest, complete min 4 views, Fluoroscopy X-ray, chest ; 2 views, front and lateral X-ray ribs, unilateral, including posteroanterior chest; min 3 views X-ray, chest ; 2 views, front and lateral X-ray ribs, bilateral, including posterioanterior chest, min 4 views X-ray, chest ; 2 views, front and lateral 0175T CAD Including Computer Algorithm Analysis Of Digital Image Data For Lesion Detection, W Further Physician Review For Interpretation And Report, W or WO Digitization Of Film Radiographic Images, Chest Radiograph(S) Performed remote from primary viewing X-ray, chest, 2 views, front and lateral; W apical lordotic procedure X-ray, chest; single view, frontal X-ray, chest, 2 views, front and lateral; W apical lordotic procedure X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections X-ray, chest, 2 views, front and lateral; W apical lordotic procedure X-ray, chest, 2 views, front and lateral; fluoroscopy X-ray, chest, 2 views, front and lateral; W apical lordotic procedure X-ray, chest, complete min 4 views X-ray, chest, 2 views, front and lateral; W apical lordotic procedure X-ray, chest, complete min 4 views, Fluoroscopy X-ray, chest, 2 views, front and lateral; W apical lordotic procedure X-ray ribs, bilateral, including posterioanterior chest, min 4 views X-ray, chest, 2 views, front and lateral; W apical lordotic procedure 0175T CAD Including Computer Algorithm Analysis Of Digital Image Data For Lesion Detection, W Further Physician Review For Interpretation And Report, W or WO Digitization Of Film Radiographic Images, Chest Radiograph(S) Performed remote from primary viewing X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections X-ray, chest, 2 views, front and lateral; fluoroscopy Chest X-ray, 2 views, front and lateral; W oblique projections X-ray, chest, complete min 4 views, Fluoroscopy 24
25 71022 Chest X-ray, 2 views, front and lateral; W oblique projections X-ray ribs, bilateral, including posterioanterior chest, min 4 views X-ray, chest, 2 views, front and lateral; W oblique projections 0175T CAD Including Computer Algorithm Analysis Of Digital Image Data For Lesion Detection, W Further Physician Review For Interpretation And Report, WOr WO Digitization Of Film Radiographic Images, Chest Radiograph(S) Performed remote from primary viewing X-ray, chest, 2 views, front and lateral; fluoroscopy X-ray, chest, complete min 4 views, Fluoroscopy X-ray, chest, 2 views, front and lateral; fluoroscopy Fluoroscopy, up to one hour physician time X-ray, chest, 2 views, front and lateral; fluoroscopy Fluoroscopy, more than one hour physician time X-ray, chest, 2 views, front and lateral; fluoroscopy X-ray, chest, complete min 4 views X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections X-ray, chest, complete min 4 views X-ray, chest, 2 views, front and lateral; fluoroscopy X-ray, chest, complete min 4 views X-ray ribs, bilateral, including posterioanterior chest, min 4 views X-ray, chest, complete min 4 views 0175T CAD Including Computer Algorithm Analysis Of Digital Image Data For Lesion Detection, W Further Physician Review For Interpretation And Report, WOr WO Digitization Of Film Radiographic Images, Chest Radiograph(S) Performed remote from primary viewing X-ray, chest, complete min 4 views, Fluoroscopy X-ray, chest, complete min 4 views X-ray, chest, complete min 4 views, Fluoroscopy Fluoroscopy, up to one hour physician time X-ray, chest, complete min 4 views, Fluoroscopy Fluoroscopy, more than one hour physician time X-ray, chest, complete min 4 views, Fluoroscopy
26 71100 X-ray, ribs, unilateral, 2 views X-ray, chest; single view, frontal X-ray ribs, unilateral, including posteroanterior chest; min 3 views X-ray, chest; single view, frontal X-ray ribs, unilateral, including posteroanterior chest; min 3 views X-ray, chest, 2 views, front and lateral; W apical lordotic procedure X-ray ribs, unilateral, including posteroanterior chest; min 3 views X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections X-ray ribs, unilateral, including posteroanterior chest; min 3 views X-ray, chest, 2 views, front and lateral; fluoroscopy X-ray ribs, unilateral, including posteroanterior chest; min 3 views X-ray, chest, complete min 4 views X-ray ribs, unilateral, including posteroanterior chest; min 3 views X-ray, chest, complete min 4 views, Fluoroscopy X-ray ribs, unilateral, including posteroanterior chest; min 3 views X-ray, Ribs Unilat 2 views X-ray, ribs, bilateral, 3 views X-ray, chest; single view, frontal X-ray, ribs, bilateral, 3 views X-ray, Ribs Unilat 2 views X-ray, ribs, bilateral, 3 views X-ray ribs, unilateral, including posteroanterior chest; min 3 views X-ray ribs, bilateral, including posterioanterior chest, min 4 views X-ray, chest; single view, frontal X-ray ribs, bilateral, including posterioanterior chest, min 4 views X-ray, ribs, unilateral, 2 views X-ray ribs, bilateral, including posterioanterior chest, min 4 views X-ray ribs, unilateral, including posteroanterior chest; min 3 views 26
27 71111 X-ray ribs, bilateral, including posterioanterior chest, min 4 views X-ray, ribs, bilateral; 3 views CT thorax, WO contrast MRI chest, WO contrast CPT Definition CT thorax, WO contrast MRI chest, W contrast CPT Definition CT thorax, WO contrast MRI Chest, WO & W contrast CPT Definition CT thorax, WO contrast CT heart, WO contrast material, W quantitative evaluation of coronary calcium CT thorax, WO contrast CT limited or localized follow-up study CT thorax, W contrast CT thorax, WO contrast CT thorax, W contrast MRI chest, WO contrast CPT Definition CT thorax, W contrast MRI chest, W contrast CPT Definition CT thorax, W contrast MRI Chest, WO & W contrast CPT Definition CT thorax, W contrast CT heart, WO contrast material, W quantitative evaluation of coronary calcium CT thorax, W contrast Fluoroscopy, up to one hour physician time CT thorax, W contrast Fluoroscopy, more than one hour physician time CT thorax, W contrast CT limited or localized follow-up study 27
28 71260 CT thorax, W contrast CT thorax, W contrast US guidance intra-operative CT thorax, W contrast CT thorax, W contrast Fluoroscopic guidance for needle placement CT thorax, WO & W contrast CT thorax, WO contrast CT thorax, WO & W contrast CT thorax, W contrast CT thorax, WO & W contrast MRI chest, WO contrast CPT Definition CT thorax, WO & W contrast MRI chest, W contrast CPT Definition CT thorax, WO & W contrast MRI Chest, WO & W contrast CPT Definition CT thorax, WO & W contrast CT heart, WO contrast material, W quantitative evaluation of coronary calcium CT thorax, WO & W contrast Fluoroscopy, up to one hour physician time CT thorax, WO & W contrast Fluoroscopy, more than one hour physician time CT thorax, WO & W contrast CT limited or localized follow-up study CT thorax, WO & W contrast
29 71270 CT thorax, WO & W contrast US guidance intra-operative CT thorax, WO & W contrast CT thorax, WO & W contrast Fluoroscopic guidance for needle placement CTA chest (noncoronary) CT thorax, WO contrast CTA chest (noncoronary) CT thorax, W contrast CTA chest (noncoronary) CT thorax, WO & W contrast CTA chest (noncoronary) Fluoroscopy, up to one hour physician time CTA chest (noncoronary) Fluoroscopy, more than one hour physician time CTA chest (noncoronary) D Rendering WO Postprocessing CTA chest (noncoronary) D Rendering W Postprocessing CTA chest (noncoronary) CT limited or localized follow-up study CTA chest (noncoronary) CTA chest (noncoronary) US guidance intra-operative CTA chest (noncoronary)
30 71275 CTA chest (noncoronary) Fluoroscopic guidance for needle placement MRI chest, W contrast MRI chest, WO contrast MRI chest, W contrast Fluoroscopy, up to one hour physician time MRI chest, W contrast Fluoroscopy, more than one hour physician time MRI chest, W contrast MRI chest, W contrast US guidance intra-operative MRI chest, W contrast MRI chest, W contrast Fluoroscopic guidance for needle placement MRI Chest, WO & W contrast MRI chest, WO contrast MRI Chest, WO & W contrast MRI chest, W contrast MRI Chest, WO & W contrast MRA chest (excluding myocardium) W/WO contrast MRI Chest, WO & W contrast Fluoroscopy, up to one hour physician time MRI Chest, WO & W contrast Fluoroscopy, more than one hour physician time MRI Chest, WO & W contrast
31 71552 MRI Chest, WO & W contrast US guidance intra-operative MRI Chest, WO & W contrast MRI Chest, WO & W contrast Fluoroscopic guidance for needle placement MRA chest (excluding myocardium) W or WO contrast CTA chest (noncoronary) CPT Definition MRA chest (excluding myocardium) W or WO contrast MRI chest, WO contrast MRA chest (excluding myocardium) W or WO contrast MRI chest, W contrast MRA chest (excluding myocardium) W or WO contrast Fluoroscopy, up to one hour physician time MRA chest (excluding myocardium) W or WO contrast Fluoroscopy, more than one hour physician time MRA chest (excluding myocardium) W or WO contrast D Rendering WO Postprocessing MRA chest (excluding myocardium) W or WO contrast D Rendering W Postprocessing MRA chest (excluding myocardium) W or WO contrast MRA chest (excluding myocardium) W or WO contrast US guidance intra-operative MRA chest (excluding myocardium) W or WO contrast MRA chest (excluding myocardium) W or WO contrast Fluoroscopic guidance for needle placement 31
32 72010 X-ray, spine, entire, survey study, anteroposterior and lateral X-ray, spine, single view, specify level X-ray, spine, entire, survey study, anteroposterior and lateral X-ray, cervical spine, 2 or 3 views X-ray, spine, entire, survey study, anteroposterior and lateral X-ray, cervical spine, min 4 views X-ray, spine, entire, survey study, anteroposterior and lateral Complete, including oblique & flex and/or extension studies X-ray, spine, entire, survey study, anteroposterior and lateral X-ray thoracolumbar spine, scoliosis X-ray, spine, entire, survey study, anteroposterior and lateral X-ray thoracic spine, 2 views X-ray, spine, entire, survey study, anteroposterior and lateral X-ray, thoracic spine, 3 views X-ray, spine, entire, survey study, anteroposterior and lateral X-ray, thoracic spine, min 4 views X-ray, spine, entire, survey study, anteroposterior and lateral Thoracolumbar 2 views X-ray, spine, entire, survey study, anteroposterior and lateral Scoliosis study, including supine and erect studies X-ray, spine, entire, survey study, anteroposterior and lateral X-ray, lumbosacral spine, 2 or 3 views X-ray, spine, entire, survey study, anteroposterior and lateral X-ray, lumbosacral spine, min 4 views X-ray, spine, entire, survey study, anteroposterior and lateral X-ray, lumbosacral spine, complete, including bending views X-ray, spine, entire, survey study, anteroposterior and lateral X-ray of the lumbar spine bending views only minimum of 4 views 32
33 72020 X-ray, spine, single view, specify level DEXA one or more sites, vertebral fracture assessment CPT Definition X-ray, cervical spine, 2 or 3 views X-ray, spine, single view, specify level CPT Definition X-ray, cervical spine, min 4 views X-ray, spine, single view, specify level X-ray, cervical spine, min 4 views X-ray, cervical spine, 2 or 3 views X-ray, spine, cervical, including oblique & flex and/or extension studies X-ray, spine, single view, specify level X-ray, spine, cervical, including oblique & flex and/or extension studies X-ray, cervical spine, 2 or 3 views X-ray, spine, cervical, including oblique & flex and/or extension studies X-ray, cervical spine, min 4 views X-ray, thoracolumbar spine, scoliosis X-ray, spine, single view, specify level CPT Definition X-ray, thoracolumbar spine, scoliosis Scoliosis study, including supine and erect studies X-ray, thoracic spine, 2 views X-ray, spine, single view, specify level CPT Definition X-ray, thoracic spine, 2 views Scoliosis study, including supine and erect studies X-ray, thoracic spine, 3 views X-ray, spine, single view, specify level CPT Definition X-ray, thoracic spine, 3 views X-ray thoracic spine, 2 views X-ray, thoracic spine, 3 views Scoliosis study, including supine and erect studies 33
34 72074 X-ray, thoracic spine, min 4 views X-ray, spine, single view, specify level CPT Definition X-ray, thoracic spine, min 4 views X-ray thoracolumbar spine, scoliosis X-ray, thoracic spine, min 4 views X-ray thoracic spine, 2 views X-ray, thoracic spine, min 4 views X-ray, thoracic spine, 3 views X-ray, thoracic spine, min 4 views Scoliosis study, including supine and erect studies X-ray, thoracolumbar spine, 2 views X-ray, spine, single view, specify level CPT Definition X-ray, thoracolumbar spine, 2 views X-ray thoracolumbar spine, scoliosis X-ray, thoracolumbar spine, 2 views X-ray thoracic spine, 2 views X-ray, thoracolumbar spine, 2 views X-ray, thoracic spine, 3 views X-ray, thoracolumbar spine, 2 views X-ray, thoracic spine, min 4 views Scoliosis study, including supine and erect studies X-ray, spine, single view, specify level CPT Definition Scoliosis study, including supine and erect studies X-ray, thoracolumbar spine, 2 views X-ray, lumbosacral spine, 2 or 3 views X-ray, spine, single view, specify level CPT Definition X-ray, lumbosacral spine, min 4 views X-ray, spine, single view, specify level 34
35 72110 X-ray, lumbosacral spine, min 4 views X-ray, lumbosacral spine, 2 or 3 views X-ray, lumbosacral spine, min 4 views X-ray, lumbosacral spine, complete, including bending views X-ray, lumbosacral spine, complete, including bending views X-ray, spine, single view, specify level CPT Definition X-ray, lumbosacral spine, complete, including bending views X-ray, lumbosacral spine, 2 or 3 views X-ray, lumbosacral spine, complete, including bending views X-ray of the lumbar spine bending views only minimum of 4 views X-ray of the lumbar spine bending views only minimum of 4 views X-ray, lumbosacral spine, 2 or 3 views CPT Definition X-ray of the lumbar spine bending views only minimum of 4 views X-ray, lumbosacral spine, min 4 views CT cervical spine WO contrast X-ray, spine, single view, specify level CPT Definition CT cervical spine WO contrast X-ray, cervical spine, 2 or 3 views CPT Definition CT cervical spine WO contrast X-ray, cervical spine, min 4 views CPT Definition CT cervical spine WO contrast Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies CPT Definition CT cervical spine WO contrast Myelography, cervical, radiological supervision and CPT Definition CT cervical spine WO contrast CT limited or localized follow-up study CT cervical spine W contrast Radiologic examination, spine, single view, specify level CPT Definition 35
36 72126 CT cervical spine W contrast X-ray, cervical spine, 2 or 3 views CPT Definition CT cervical spine W contrast X-ray, cervical spine, min 4 views CPT Definition CT cervical spine W contrast Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies CPT Definition CT cervical spine W contrast CT cervical spine WO contrast CT cervical spine W contrast Myelography, cervical, radiological supervision and CPT Definition CT cervical spine W contrast Fluoroscopy, up to one hour physician time CT cervical spine W contrast Fluoroscopy, more than one hour physician time CT cervical spine W contrast CT limited or localized follow-up study CT cervical spine W contrast CT cervical spine W contrast US guidance intra-operative CT cervical spine W contrast CT cervical spine W contrast Fluoroscopic guidance for needle placement CT cervical spine WO & W contrast X-ray, cervical spine, 2 or 3 views CPT Definition CT cervical spine WO & W contrast CT cervical spine WO contrast 36
37 72127 CT cervical spine WO & W contrast CT cervical spine W contrast CT cervical spine WO & W contrast Fluoroscopy, up to one hour physician time CT cervical spine WO & W contrast Fluoroscopy, more than one hour physician time CT cervical spine WO & W contrast CT limited or localized follow-up study CT cervical spine WO & W contrast CT cervical spine WO & W contrast US guidance intra-operative CT cervical spine WO & W contrast CT cervical spine WO & W contrast Fluoroscopic guidance for needle placement CT thoracic spine WO contrast X-ray thoracic spine, 2 views CPT Definition CT thoracic spine WO contrast X-ray, thoracic spine, 3 views CPT Definition CT thoracic spine WO contrast X-ray, thoracic spine, min 4 views CPT Definition CT thoracic spine WO contrast Thoracolumbar 2 views CPT Definition CT thoracic spine WO contrast Myelography, thoracic, radiological supervision and CPT Definition CT thoracic spine WO contrast CT guidance percutaneous vertebroplasty 37
38 72128 CT thoracic spine WO contrast CT limited or localized follow-up study CT thoracic spine W contrast X-ray thoracic spine, 2 views CPT Definition CT thoracic spine W contrast X-ray, thoracic spine, 3 views CPT Definition CT thoracic spine W contrast X-ray, thoracic spine, min 4 views CPT Definition CT thoracic spine W contrast Thoracolumbar 2 views CPT Definition CT thoracic spine W contrast CT thoracic spine WO contrast CT thoracic spine W contrast Myelography, thoracic, radiological supervision and CPT Definition CT thoracic spine W contrast CT guidance percutaneous vertebroplasty CT thoracic spine W contrast Fluoroscopy, up to one hour physician time CT thoracic spine W contrast Fluoroscopy, more than one hour physician time CT thoracic spine W contrast CT limited or localized follow-up study CT thoracic spine W contrast CT thoracic spine W contrast US guidance intra-operative CT thoracic spine W contrast
39 72129 CT thoracic spine W contrast Fluoroscopic guidance for needle placement CT thoracic spine WO & W contrast X-ray thoracic spine, 2 views CPT Definition CT thoracic spine WO & W contrast X-ray, thoracic spine, 3 views CPT Definition CT thoracic spine WO & W contrast X-ray, thoracic spine, min 4 views CPT Definition CT thoracic spine WO & W contrast Thoracolumbar 2 views CPT Definition CT thoracic spine WO & W contrast CT thoracic spine WO contrast CT thoracic spine WO & W contrast CT thoracic spine W contrast CT thoracic spine WO & W contrast CT guidance percutaneous vertebroplasty CT thoracic spine WO & W contrast Fluoroscopy, up to one hour physician time CT thoracic spine WO & W contrast Fluoroscopy, more than one hour physician time CT thoracic spine WO & W contrast CT limited or localized follow-up study CT thoracic spine WO & W contrast CT thoracic spine WO & W contrast US guidance intra-operative CT thoracic spine WO & W contrast
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