Horizon Blue Cross Blue Shield of NJ Radiology Rules Bank



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Horizon Blue Cross Blue Shield of NJ Radiology Rules Bank * Rule added 05/30/13 Code Pay Code Do Not Pay Source 70010 Myelography, posterior fossa, radiological supervision and 76000 Fluoroscopy, up to one hour physician time 70010 Myelography, posterior fossa, radiological supervision and 76001 Fluoroscopy, more than one hour physician time 70010 Myelography, posterior fossa, radiological supervision and 77001 70010 Myelography, posterior fossa, radiological supervision and 77002 Fluoroscopic guidance for needle placement 70010 Myelography, posterior fossa, radiological supervision and 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures 70015 Cisternography, positive contrast, radiological supervision and 76000 Fluoroscopy, up to one hour physician time 70015 Cisternography, positive contrast, radiological supervision and 76001 Fluoroscopy, more than one hour physician time 70015 Cisternography, positive contrast, radiological supervision and 77001 70015 Cisternography, positive contrast, radiological supervision and 77002 Fluoroscopic guidance for needle placement 70015 Cisternography, positive contrast, radiological supervision and 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures 70110 X-ray, mandible; complete, min of 4 views 70100 X-ray, mandible, partial, < 4 views 70130 X-ray, mastoids, complete, min of 3 views per side 70120 X-ray, mastoids, < 3 views per side 70150 X-ray facial bones, complete, min of 3 views 70140 X-ray, facial bones, < 3 views 1

70170 Dacryocystography, nasolacrimal duct, radiological supervision and 76000 Fluoroscopy, up to one hour physician time 70170 Dacryocystography, nasolacrimal duct, radiological supervision and 76001 Fluoroscopy, more than one hour physician time 70170 Dacryocystography, nasolacrimal duct, radiological supervision and 77001 70170 Dacryocystography, nasolacrimal duct, radiological supervision and 77002 Fluoroscopic guidance for needle placement 70170 Dacryocystography, nasolacrimal duct, radiological supervision and 78660 Radiopharmaceutical dacryocystography 70220 X-rays, sinuses, paranasal, complete min of 3 views 70210 X-ray, sinuses, paranasal, < 3 views 70260 Complete, min of 4 views 70250 X-ray, skull, < 4 views 70310 X-ray exam of teeth, single view 70300 X-ray exam of teeth, single view 70320 X-ray exam teeth; complete full mouth 70300 X-ray exam of teeth, single view CPT Definition 70320 X-ray exam teeth; complete full mouth 70310 X-ray exam of teeth, single view CPT Definition 70330 X-ray TMJ, bilateral 70328 X-ray TMJ, unilateral 70332 TMJ arthrography, radiological supervision and 76000 Fluoroscopy, up to one hour physician time 70332 TMJ arthrography, radiological supervision and 76001 Fluoroscopy, more than one hour physician time 70332 TMJ arthrography, radiological supervision and 77001 2

70332 TMJ arthrography, radiological supervision and 77002 Fluoroscopic guidance for needle placement 70336 MRI, TMJ 70332 TMJ arthrography, radiological supervision and CPT Definition 70355 Panoramic X-ray of Jaws 70300 X-ray exam of teeth, single view 70355 Panoramic X-ray of Jaws 70310 X-ray exam of teeth, single view 70355 Panoramic X-ray of Jaws 70320 X-ray exam teeth; complete full mouth 70370 Pharynx or larynx, including fluoro and/or magnification technique 70360 X-ray, neck, soft tissue 70370 Pharynx or larynx, including fluoro and/or magnification technique 74210 X-ray, pharynx and/or cervical esophagus 70370 Pharynx or larynx, including fluoro and/or magnification technique 74230 Swallowing function W cineradiography /videoradiography 70370 Pharynx or larynx, including fluoro and/or magnification technique 76000 Fluoroscopy, up to one hour physician time 70370 Pharynx or larynx, including fluoro and/or magnification technique 76001 Fluoroscopy, more than one hour physician time 70370 Pharynx or larynx, including fluoro and/or magnification technique 77001 70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording 70370 Pharynx or larynx, including fluoro and/or magnification technique 70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording 74210 X-ray, pharynx and/or cervical esophagus 70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording 74230 Swallowing function W cineradiography /videoradiography 3

70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording 74240 X-ray GI tract, upper, W or WO delayed films, WO KUB CPT Definition 70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording 76000 Fluoroscopy, up to one hour physician time 70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording 76001 Fluoroscopy, more than one hour physician time 70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording 77001 70373 Laryngography, contrast, radiological supervision and 76000 Fluoroscopy, up to one hour physician time 70373 Laryngography, contrast, radiological supervision and 76001 Fluoroscopy, more than one hour physician time 70373 Laryngography, contrast, radiological supervision and 77001 70390 Sialography, radiological supervision and 76000 Fluoroscopy, up to one hour physician time 70390 Sialography, radiological supervision and 76001 Fluoroscopy, more than one hour physician time 70390 Sialography, radiological supervision and 77001 70390 Sialography, radiological supervision and 77002 Fluoroscopic guidance for needle placement 70450 CT head WO contrast 70480 CT orbit WO contrast 70450 CT head WO contrast 70481 CT orbit W contrast 70450 CT head WO contrast 70482 CT orbit WO & W contrast 4

70450 CT head WO contrast 76380 CT limited or localized follow-up study 70460 CT Head W contrast 70450 CT head WO contrast 70460 CT Head W contrast 70480 CT orbit WO contrast 70460 CT Head W contrast 70481 CT orbit W contrast 70460 CT Head W contrast 70482 CT orbit WO & W contrast 70460 CT Head W contrast 76000 Fluoroscopy, up to one hour physician time 70460 CT Head W contrast 76001 Fluoroscopy, more than one hour physician time 70460 CT Head W contrast 76380 CT limited or localized follow-up study 70460 CT Head W contrast 76942 70460 CT Head W contrast 76998 US guidance intra-operative 70460 CT Head W contrast 77001 70460 CT Head W contrast 77002 Fluoroscopic guidance for needle placement 70470 CT head WO & W contrast 70450 CT head WO contrast 70470 CT head WO & W contrast 70460 CT head W contrast 5

70470 CT head WO & W contrast 70480 CT orbit WO contrast 70470 CT head WO & W contrast 70481 CT orbit W contrast 70470 CT head WO & W contrast 70482 CT orbit WO & W contrast 70470 CT head WO & W contrast 76000 Fluoroscopy, up to one hour physician time 70470 CT head WO & W contrast 76001 Fluoroscopy, more than one hour physician time 70470 CT head WO & W contrast 76380 CT limited or localized follow-up study 70470 CT head WO & W contrast 76942 70470 CT head WO & W contrast 76998 US guidance intra-operative 70470 CT head WO & W contrast 77001 70470 CT head WO & W contrast 77002 Fluoroscopic guidance for needle placement 70480 CT orbit,sella, posterior fossa, outer, middle or inner ear, WO contrast 70542 MRI orbit, face, neck, W contrast CPT Definition 70480 CT orbit,sella, posterior fossa, outer, middle or inner ear, WO contrast 70543 MRI face, orbit, face, WO & W contrast CPT Definition 70480 CT orbit,sella, posterior fossa, outer, middle or inner ear, WO contrast 76380 CT limited or localized follow-up study 70481 CT orbit, sella, W contrast 70480 CT orbit,sella, posterior fossa, outer, middle or inner ear, WO contrast 6

70481 CT orbit, sella, W contrast 70540 MRI orbit, face, neck, WO contrast CPT Definition 70481 CT orbit, sella, W contrast 70542 MRI orbit, face, neck, W contrast CPT Definition 70481 CT orbit, sella, W contrast 70543 MRI face, orbit, face, WO & W contrast CPT Definition 70481 CT orbit, sella, W contrast 76000 Fluoroscopy, up to one hour physician time 70481 CT orbit, sella, W contrast 76001 Fluoroscopy, more than one hour physician time 70481 CT orbit, sella, W contrast 76380 CT limited or localized follow-up study 70481 CT orbit, sella, W contrast 76942 70481 CT orbit, sella, W contrast 76998 US guidance intra-operative 70481 CT orbit, sella, W contrast 77001 70481 CT orbit, sella, W contrast 77002 Fluoroscopic guidance for needle placement 70482 CT orbit WO & W contrast 70480 CT orbit WO contrast 70482 CT orbit WO & W contrast 70481 CT orbit W contrast 70482 CT orbit WO & W contrast 70540 MRI orbit, face, neck, WO contrast CPT Definition 70482 CT orbit WO & W contrast 70542 MRI orbit, face, neck, W contrast CPT Definition 7

70482 CT orbit WO & W contrast 70543 MRI face, orbit, face, WO & W contrast CPT Definition 70482 CT orbit WO & W contrast 76000 Fluoroscopy, up to one hour physician time 70482 CT orbit WO & W contrast 76001 Fluoroscopy, more than one hour physician time 70482 CT orbit WO & W contrast 76380 CT limited or localized follow-up study 70482 CT orbit WO & W contrast 76942 70482 CT orbit WO & W contrast 76998 US guidance intra-operative 70482 CT orbit WO & W contrast 77001 70482 CT orbit WO & W contrast 77002 Fluoroscopic guidance for needle placement 70486 CT maxillofacial WO contrast 76380 CT limited or localized follow-up study 70487 CT maxillofacial W contrast 70486 CT maxillofacial area, WO contrast 70487 CT maxillofacial W contrast 76000 Fluoroscopy, up to one hour physician time 70487 CT maxillofacial W contrast 76001 Fluoroscopy, more than one hour physician time 70487 CT maxillofacial W contrast 76380 CT limited or localized follow-up study 70487 CT maxillofacial W contrast 76942 8

70487 CT maxillofacial W contrast 76998 US guidance intra-operative 70487 CT maxillofacial W contrast 77001 70487 CT maxillofacial W contrast 77002 Fluoroscopic guidance for needle placement 70488 CT maxillofacial WO & W contrast 70486 CT maxillofacial area, WO contrast 70488 CT maxillofacial WO & W contrast 70487 CT maxillofacial area, W contrast 70488 CT maxillofacial WO & W contrast 76000 Fluoroscopy, up to one hour physician time 70488 CT maxillofacial WO & W contrast 76001 Fluoroscopy, more than one hour physician time 70488 CT maxillofacial WO & W contrast 76380 CT limited or localized follow-up study 70488 CT maxillofacial WO & W contrast 76942 70488 CT maxillofacial WO & W contrast 76998 US guidance intra-operative 70488 CT maxillofacial WO & W contrast 77001 70488 CT maxillofacial WO & W contrast 77002 Fluoroscopic guidance for needle placement 70490 CT soft tissue neck, WO contrast 70540 MRI orbit, face, neck, WO contrast CPT Definition 70490 CT soft tissue neck, WO contrast 70542 MRI orbit, face, neck, W contrast CPT Definition 9

70490 CT soft tissue neck, WO contrast 70543 MRI face, orbit, face, WO & W contrast CPT Definition 70490 CT soft tissue neck, WO contrast 76380 CT limited or localized follow-up study 70490 CT soft tissue neck, WO contrast 78072 Parathyroid planar imaging; * 70491 CT soft tissue, neck, W contrast 70490 CT soft tissue neck WO contrast 70491 CT soft tissue, neck, W contrast 70540 MRI orbit, face, neck, WO contrast CPT Definition 70491 CT soft tissue, neck, W contrast 70542 MRI orbit, face, neck, W contrast CPT Definition 70491 CT soft tissue, neck, W contrast 70543 MRI face, orbit, face, WO & W contrast CPT Definition 70491 CT soft tissue, neck, W contrast 76000 Fluoroscopy, up to one hour physician time 70491 CT soft tissue, neck, W contrast 76001 Fluoroscopy, more than one hour physician time 70491 CT soft tissue, neck, W contrast 76380 CT limited or localized follow-up study 70491 CT soft tissue, neck, W contrast 76942 70491 CT soft tissue, neck, W contrast 77001 70491 CT soft tissue, neck, W contrast 77002 Fluoroscopic guidance for needle placement 70491 CT soft tissue, neck, W contrast 78072 Parathyroid planar imaging; * 10

70492 CT soft tissue, neck, WO & W contrast 70490 CT soft tissue neck WO contrast 70492 CT soft tissue, neck, WO & W contrast 70491 CT soft tissue, neck W contrast 70492 CT soft tissue, neck, WO & W contrast 70540 MRI orbit, face, neck, WO contrast CPT Definition 70492 CT soft tissue, neck, WO & W contrast 70542 MRI orbit, face, neck, W contrast CPT Definition 70492 CT soft tissue, neck, WO & W contrast 70543 MRI face, orbit, face, WO & W contrast CPT Definition 70492 CT soft tissue, neck, WO & W contrast 76000 Fluoroscopy, up to one hour physician time 70492 CT soft tissue, neck, WO & W contrast 76001 Fluoroscopy, more than one hour physician time 70492 CT soft tissue, neck, WO & W contrast 76380 CT limited or localized follow-up study 70492 CT soft tissue, neck, WO & W contrast 76942 70492 CT soft tissue, neck, WO & W contrast 76998 US guidance intra-operative 70492 CT soft tissue, neck, WO & W contrast 77001 70492 CT soft tissue, neck, WO & W contrast 77002 Fluoroscopic guidance for needle placement 70492 CT soft tissue, neck, WO & W contrast 78072 Parathyroid planar imaging; * 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 70450 CT head WO contrast 11

70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 70460 CT head W contrast 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 70470 CT head WO & W contrast 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 76000 Fluoroscopy, up to one hour physician time 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 76001 Fluoroscopy, more than one hour physician time 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 76376 3D Rendering WO Postprocessing 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 76377 3D Rendering W Postprocessing 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 76380 CT limited or localized follow-up study 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 76942 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 76998 US guidance intra-operative 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 77001 70496 CTA head W contrast, including noncontrast images, if performed, and image postprocessing 77002 Fluoroscopic guidance for needle placement 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 70490 CT soft tissue neck WO contrast 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 70491 CT soft tissue, neck W contrast 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 70492 CT soft tissue neck WO & W contrast 12

70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 76000 Fluoroscopy, up to one hour physician time 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 76001 Fluoroscopy, more than one hour physician time 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 76376 3D Rendering WO Postprocessing 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 76377 3D Rendering W Postprocessing 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 76380 CT limited or localized follow-up study 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 76942 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 76998 US guidance intra-operative 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 77001 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing 77002 Fluoroscopic guidance for needle placement 70540 MRI orbit, face and/or neck WO contrast 70547 MRA neck WO contrast 70540 MRI orbit, face and/or neck WO contrast 70548 MRA neck W contrast 70542 MRI orbit, face and/or neck, W contrast 70540 MRI orbit, face, neck, WO contrast 70542 MRI orbit, face and/or neck, W contrast 76000 Fluoroscopy, up to one hour physician time 70542 MRI orbit, face and/or neck, W contrast 76001 Fluoroscopy, more than one hour physician time 13

70542 MRI orbit, face and/or neck, W contrast 76942 70542 MRI orbit, face and/or neck, W contrast 76998 US guidance intra-operative 70542 MRI orbit, face and/or neck, W contrast 77001 70542 MRI orbit, face and/or neck, W contrast 77002 Fluoroscopic guidance for needle placement 70543 MRI orbit, face and/or neck, WO & W contrast 70540 MRI orbit, face, neck, WO contrast 70543 MRI orbit, face and/or neck, WO & W contrast 70542 MRI orbit, face, neck, W contrast 70543 MRI orbit, face and/or neck, WO & W contrast 76000 Fluoroscopy, up to one hour physician time 70543 MRI orbit, face and/or neck, WO & W contrast 76001 Fluoroscopy, more than one hour physician time 70543 MRI orbit, face and/or neck, WO & W contrast 76942 70543 MRI orbit, face and/or neck, WO & W contrast 76998 US guidance intra-operative 70543 MRI orbit, face and/or neck, WO & W contrast 77001 70543 MRI orbit, face and/or neck, WO & W contrast 77002 Fluoroscopic guidance for needle placement 70544 MRA, head WO contrast 70496 CTA head CPT Definition 70544 MRA, head WO contrast 76376 3D Rendering WO Postprocessing 14

70544 MRA, head WO contrast 76377 3D Rendering W Postprocessing 70545 MRA, head W contrast 70496 CTA head CPT Definition 70545 MRA, head W contrast 70544 MRA head, WO contrast 70545 MRA, head W contrast 76000 Fluoroscopy, up to one hour physician time 70545 MRA, head W contrast 76001 Fluoroscopy, more than one hour physician time 70545 MRA, head W contrast 76376 3D Rendering WO Postprocessing 70545 MRA, head W contrast 76377 3D Rendering W Postprocessing 70545 MRA, head W contrast 76942 70545 MRA, head W contrast 76998 US guidance intra-operative 70545 MRA, head W contrast 77001 70545 MRA, head W contrast 77002 Fluoroscopic guidance for needle placement 70546 MRA, head WO & W contrast 70496 CTA head CPT Definition 70546 MRA, head WO & W contrast 70544 MRA head, WO contrast 70546 MRA, head WO & W contrast 70545 MRA head, W contrast 15

70546 MRA, head WO & W contrast 76000 Fluoroscopy, up to one hour physician time 70546 MRA, head WO & W contrast 76001 Fluoroscopy, more than one hour physician time 70546 MRA, head WO & W contrast 76376 3D Rendering WO Postprocessing 70546 MRA, head WO & W contrast 76377 3D Rendering W Postprocessing 70546 MRA, head WO & W contrast 76942 70546 MRA, head WO & W contrast 76998 US guidance intra-operative 70546 MRA, head WO & W contrast 77001 70546 MRA, head WO & W contrast 77002 Fluoroscopic guidance for needle placement 70547 MRA, neck WO contrast 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CPT Definition 70547 MRA, neck WO contrast 76000 Fluoroscopy, up to one hour physician time 70547 MRA, neck WO contrast 76001 Fluoroscopy, more than one hour physician time 70547 MRA, neck WO contrast 76376 3D Rendering WO Postprocessing 70547 MRA, neck WO contrast 76377 3D Rendering W Postprocessing 70547 MRA, neck WO contrast 76942 16

70547 MRA, neck WO contrast 76998 US guidance intra-operative 70547 MRA, neck WO contrast 77001 70547 MRA, neck WO contrast 77002 Fluoroscopic guidance for needle placement 70548 MRA neck W contrast 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CPT Definition 70548 MRA neck W contrast 70547 MRA neck WO contrast 70548 MRA neck W contrast 76000 Fluoroscopy, up to one hour physician time 70548 MRA neck W contrast 76001 Fluoroscopy, more than one hour physician time 70548 MRA neck W contrast 76376 3D Rendering WO Postprocessing 70548 MRA neck W contrast 76377 3D Rendering W Postprocessing 70548 MRA neck W contrast 76942 70548 MRA neck W contrast 76998 US guidance intra-operative 70548 MRA neck W contrast 77001 70548 MRA neck W contrast 77002 Fluoroscopic guidance for needle placement 70549 MRA neck WO & W contrast 70498 CTA neck W contrast, including noncontrast images, if performed, and image postprocessing CPT Definition 17

70549 MRA neck WO & W contrast 70547 MRA neck WO contrast 70549 MRA neck WO & W contrast 70548 MRA neck W contrast 70549 MRA neck WO & W contrast 76000 Fluoroscopy, up to one hour physician time 70549 MRA neck WO & W contrast 76001 Fluoroscopy, more than one hour physician time 70549 MRA neck WO & W contrast 76376 3D Rendering WO Postprocessing 70549 MRA neck WO & W contrast 76377 3D Rendering W Postprocessing 70549 MRA neck WO & W contrast 76942 70549 MRA neck WO & W contrast 76998 US guidance intra-operative 70549 MRA neck WO & W contrast 77001 70549 MRA neck WO & W contrast 77002 Fluoroscopic guidance for needle placement 70551 MRI brain WO contrast 70555 MRI brain, functional, W neuro functioning test by physician or psychologist 70551 MRI brain WO contrast 70557 MRI brain, during open intracranial procedure; WO contrast 70552 MRI brain WO contrast 70551 MRI brain WO contrast 70552 MRI brain W contrast 70554 MRI brain, functional, WO neuro functioning test by physician or psychologist 18

70552 MRI brain W contrast 70555 MRI brain, functional, W neuro functioning test by physician or psychologist 70552 MRI brain W contrast 76000 Fluoroscopy, up to one hour physician time 70552 MRI brain W contrast 76001 Fluoroscopy, more than one hour physician time 70552 MRI brain W contrast 76942 70552 MRI brain W contrast 76998 US guidance intra-operative 70552 MRI brain W contrast 77001 70552 MRI brain W contrast 77002 Fluoroscopic guidance for needle placement 70553 MRI brain WO & W contrast 70551 MRI brain WO contrast 70553 MRI brain WO & W contrast 70552 MRI brain W contrast 70553 MRI brain WO & W contrast 70554 MRI brain, functional, WO neuro functioning test by physician or psychologist 70553 MRI brain WO & W contrast 70555 MRI brain, functional, W neuro functioning test by physician or psychologist 70553 MRI brain WO & W contrast 76000 Fluoroscopy, up to one hour physician time 70553 MRI brain WO & W contrast 76001 Fluoroscopy, more than one hour physician time 70553 MRI brain WO & W contrast 76942 19

70553 MRI brain WO & W contrast 76998 US guidance intra-operative 70553 MRI brain WO & W contrast 77001 70553 MRI brain WO & W contrast 77002 Fluoroscopic guidance for needle placement 70554 MRI brain, functional, WO neuro functioning test by physician or psychologist 70551 MRI brain WO contrast 70554 MRI brain, functional, WO neuro functioning test by physician or psychologist 70557 MRI brain, during open intracranial procedure; WO contrast 70554 MRI brain, functional, WO neuro functioning test by physician or psychologist 70558 MRI brain, during open intracranial procedure; W contrast 70554 MRI brain, functional, WO neuro functioning test by physician or psychologist 70559 MRI brain, during open intracranial procedure; WO & W contrast 70555 MRI brain, functional, W neuro functioning test by physician or psychologist 70554 MRI brain, functional, WO neuro functioning test by physician or psychologist 70555 MRI brain, functional, W neuro functioning test by physician or psychologist 70557 MRI brain, during open intracranial procedure; WO contrast 70555 MRI brain, functional, W neuro functioning test by physician or psychologist 70558 MRI brain, during open intracranial procedure; W contrast 70555 MRI brain, functional, W neuro functioning test by physician or psychologist 70559 MRI brain, during open intracranial procedure; WO & W contrast 70557 MRI brain, during open intracranial procedure; WO contrast 70544 MRA head, WO contrast 70557 MRI brain, during open intracranial procedure; WO contrast 70545 MRA head, W contrast 70557 MRI brain, during open intracranial procedure; WO contrast 70546 MRA head WO & W contrast 20

70557 MRI brain, during open intracranial procedure; WO contrast 70552 MRI brain W contrast 70557 MRI brain, during open intracranial procedure; WO contrast 70553 MRI brain WO & W contrast 70557 MRI brain, during open intracranial procedure; WO contrast 77021 MR guidance for needle placement radiological supervision and 70558 MRI brain, during open intracranial procedure; W contrast 70544 MRA head, WO contrast 70558 MRI brain, during open intracranial procedure; W contrast 70545 MRA head, W contrast 70558 MRI brain, during open intracranial procedure; W contrast 70546 MRA head WO & W contrast 70558 MRI brain, during open intracranial procedure; W contrast 70551 MRI brain WO contrast 70558 MRI brain, during open intracranial procedure; W contrast 70552 MRI brain W contrast 70558 MRI brain, during open intracranial procedure; W contrast 70553 MRI brain WO & W contrast 70558 MRI brain, during open intracranial procedure; W contrast 70557 MRI brain, during open intracranial procedure; WO contrast 70558 MRI brain, during open intracranial procedure; W contrast 76000 Fluoroscopy, up to one hour physician time 70558 MRI brain, during open intracranial procedure; W contrast 76001 Fluoroscopy, more than one hour physician time 70558 MRI brain, during open intracranial procedure; W contrast 76942 70558 MRI brain, during open intracranial procedure; W contrast 77001 21

70558 MRI brain, during open intracranial procedure; W contrast 77002 Fluoroscopic guidance for needle placement 70558 MRI brain, during open intracranial procedure; W contrast 77021 MR guidance for needle placement radiological supervision and 70559 MRI brain, during open intracranial procedure; WO & W contrast 70544 MRA head, WO contrast 70559 MRI brain, during open intracranial procedure; WO & W contrast 70545 MRA head, W contrast 70559 MRI brain, during open intracranial procedure; WO & W contrast 70546 MRA head WO & W contrast 70559 MRI brain, during open intracranial procedure; WO & W contrast 70551 MRI brain WO contrast 70559 MRI brain, during open intracranial procedure; WO & W contrast 70552 MRI brain W contrast 70559 MRI brain, during open intracranial procedure; WO & W contrast 70553 MRI brain WO & W contrast 70559 MRI brain, during open intracranial procedure; WO & W contrast 70557 MRI brain, during open intracranial procedure; WO contrast 70559 MRI brain, during open intracranial procedure; WO & W contrast 70558 MRI brain, during open intracranial procedure; W contrast 70559 MRI brain, during open intracranial procedure; WO & W contrast 76000 Fluoroscopy, up to one hour physician time 70559 MRI brain, during open intracranial procedure; WO & W contrast 76001 Fluoroscopy, more than one hour physician time 70559 MRI brain, during open intracranial procedure; WO & W contrast 76942 70559 MRI brain, during open intracranial procedure; WO & W contrast 77001 22

70559 MRI brain, during open intracranial procedure; WO & W contrast 77002 Fluoroscopic guidance for needle placement 70559 MRI brain, during open intracranial procedure; WO & W contrast 77021 MR guidance for needle placement radiological supervision and 71010 X-ray, chest; single view, frontal 71022 X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections 71010 X-ray, chest; single view, frontal 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 71010 X-ray, chest; single view, frontal 71030 X-ray, chest, complete min 4 views 71010 X-ray, chest; single view, frontal 71034 X-ray, chest, complete min 4 views, Fluoroscopy 71010 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 71015 X-ray, chest; single view, stereo, frontal 71010 X-ray, chest; single view, frontal 71015 X-ray, chest; single view, stereo, frontal 71020 X-ray, chest ; 2 views, front and lateral 71015 X-ray, chest; single view, stereo, frontal 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 71020 X-ray, chest ; 2 views, front and lateral 71010 X-ray, chest ; 2 views, front and lateral 71020 X-ray, chest ; 2 views, front and lateral 71021 X-ray, chest, 2 views, front and lateral; W apical lordotic procedure 71020 X-ray, chest ; 2 views, front and lateral 71022 X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections 71020 X-ray, chest ; 2 views, front and lateral 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 23

71020 X-ray, chest ; 2 views, front and lateral 71030 X-ray, chest, complete min 4 views 71020 X-ray, chest ; 2 views, front and lateral 71034 X-ray, chest, complete min 4 views, Fluoroscopy 71020 X-ray, chest ; 2 views, front and lateral 71101 X-ray ribs, unilateral, including posteroanterior chest; min 3 views 71020 X-ray, chest ; 2 views, front and lateral 71111 X-ray ribs, bilateral, including posterioanterior chest, min 4 views 71020 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 71021 X-ray, chest, 2 views, front and lateral; W apical lordotic procedure 71010 X-ray, chest; single view, frontal 71021 X-ray, chest, 2 views, front and lateral; W apical lordotic procedure 71022 X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections 71021 X-ray, chest, 2 views, front and lateral; W apical lordotic procedure 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 71021 X-ray, chest, 2 views, front and lateral; W apical lordotic procedure 71030 X-ray, chest, complete min 4 views 71021 X-ray, chest, 2 views, front and lateral; W apical lordotic procedure 71034 X-ray, chest, complete min 4 views, Fluoroscopy 71021 X-ray, chest, 2 views, front and lateral; W apical lordotic procedure 71111 X-ray ribs, bilateral, including posterioanterior chest, min 4 views 71021 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 71022 X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 71022 Chest X-ray, 2 views, front and lateral; W oblique projections 71034 X-ray, chest, complete min 4 views, Fluoroscopy 24

71022 Chest X-ray, 2 views, front and lateral; W oblique projections 71111 X-ray ribs, bilateral, including posterioanterior chest, min 4 views 71022 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 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 71034 X-ray, chest, complete min 4 views, Fluoroscopy 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 76000 Fluoroscopy, up to one hour physician time 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 76001 Fluoroscopy, more than one hour physician time 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 77001 71030 X-ray, chest, complete min 4 views 71022 X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections 71030 X-ray, chest, complete min 4 views 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 71030 X-ray, chest, complete min 4 views 71111 X-ray ribs, bilateral, including posterioanterior chest, min 4 views 71030 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 71034 X-ray, chest, complete min 4 views, Fluoroscopy 71030 X-ray, chest, complete min 4 views 71034 X-ray, chest, complete min 4 views, Fluoroscopy 76000 Fluoroscopy, up to one hour physician time 71034 X-ray, chest, complete min 4 views, Fluoroscopy 76001 Fluoroscopy, more than one hour physician time 71034 X-ray, chest, complete min 4 views, Fluoroscopy 77001 25

71100 X-ray, ribs, unilateral, 2 views 71010 X-ray, chest; single view, frontal 71101 X-ray ribs, unilateral, including posteroanterior chest; min 3 views 71010 X-ray, chest; single view, frontal 71101 X-ray ribs, unilateral, including posteroanterior chest; min 3 views 71021 X-ray, chest, 2 views, front and lateral; W apical lordotic procedure 71101 X-ray ribs, unilateral, including posteroanterior chest; min 3 views 71022 X-ray, chest Chest X-ray, 2 views, front and lateral; W oblique projections 71101 X-ray ribs, unilateral, including posteroanterior chest; min 3 views 71023 X-ray, chest, 2 views, front and lateral; fluoroscopy 71101 X-ray ribs, unilateral, including posteroanterior chest; min 3 views 71030 X-ray, chest, complete min 4 views 71101 X-ray ribs, unilateral, including posteroanterior chest; min 3 views 71034 X-ray, chest, complete min 4 views, Fluoroscopy 71101 X-ray ribs, unilateral, including posteroanterior chest; min 3 views 71100 X-ray, Ribs Unilat 2 views 71110 X-ray, ribs, bilateral, 3 views 71010 X-ray, chest; single view, frontal 71110 X-ray, ribs, bilateral, 3 views 71100 X-ray, Ribs Unilat 2 views 71110 X-ray, ribs, bilateral, 3 views 71101 X-ray ribs, unilateral, including posteroanterior chest; min 3 views 71111 X-ray ribs, bilateral, including posterioanterior chest, min 4 views 71010 X-ray, chest; single view, frontal 71111 X-ray ribs, bilateral, including posterioanterior chest, min 4 views 71100 X-ray, ribs, unilateral, 2 views 71111 X-ray ribs, bilateral, including posterioanterior chest, min 4 views 71101 X-ray ribs, unilateral, including posteroanterior chest; min 3 views 26

71111 X-ray ribs, bilateral, including posterioanterior chest, min 4 views 71110 X-ray, ribs, bilateral; 3 views 71250 CT thorax, WO contrast 71550 MRI chest, WO contrast CPT Definition 71250 CT thorax, WO contrast 71551 MRI chest, W contrast CPT Definition 71250 CT thorax, WO contrast 71552 MRI Chest, WO & W contrast CPT Definition 71250 CT thorax, WO contrast 75571 CT heart, WO contrast material, W quantitative evaluation of coronary calcium 71250 CT thorax, WO contrast 76380 CT limited or localized follow-up study 71260 CT thorax, W contrast 71250 CT thorax, WO contrast 71260 CT thorax, W contrast 71550 MRI chest, WO contrast CPT Definition 71260 CT thorax, W contrast 71551 MRI chest, W contrast CPT Definition 71260 CT thorax, W contrast 71552 MRI Chest, WO & W contrast CPT Definition 71260 CT thorax, W contrast 75571 CT heart, WO contrast material, W quantitative evaluation of coronary calcium 71260 CT thorax, W contrast 76000 Fluoroscopy, up to one hour physician time 71260 CT thorax, W contrast 76001 Fluoroscopy, more than one hour physician time 71260 CT thorax, W contrast 76380 CT limited or localized follow-up study 27

71260 CT thorax, W contrast 76942 71260 CT thorax, W contrast 76998 US guidance intra-operative 71260 CT thorax, W contrast 77001 71260 CT thorax, W contrast 77002 Fluoroscopic guidance for needle placement 71270 CT thorax, WO & W contrast 71250 CT thorax, WO contrast 71270 CT thorax, WO & W contrast 71260 CT thorax, W contrast 71270 CT thorax, WO & W contrast 71550 MRI chest, WO contrast CPT Definition 71270 CT thorax, WO & W contrast 71551 MRI chest, W contrast CPT Definition 71270 CT thorax, WO & W contrast 71552 MRI Chest, WO & W contrast CPT Definition 71270 CT thorax, WO & W contrast 75571 CT heart, WO contrast material, W quantitative evaluation of coronary calcium 71270 CT thorax, WO & W contrast 76000 Fluoroscopy, up to one hour physician time 71270 CT thorax, WO & W contrast 76001 Fluoroscopy, more than one hour physician time 71270 CT thorax, WO & W contrast 76380 CT limited or localized follow-up study 71270 CT thorax, WO & W contrast 76942 28

71270 CT thorax, WO & W contrast 76998 US guidance intra-operative 71270 CT thorax, WO & W contrast 77001 71270 CT thorax, WO & W contrast 77002 Fluoroscopic guidance for needle placement 71275 CTA chest (noncoronary) 71250 CT thorax, WO contrast 71275 CTA chest (noncoronary) 71260 CT thorax, W contrast 71275 CTA chest (noncoronary) 71270 CT thorax, WO & W contrast 71275 CTA chest (noncoronary) 76000 Fluoroscopy, up to one hour physician time 71275 CTA chest (noncoronary) 76001 Fluoroscopy, more than one hour physician time 71275 CTA chest (noncoronary) 76376 3D Rendering WO Postprocessing 71275 CTA chest (noncoronary) 76377 3D Rendering W Postprocessing 71275 CTA chest (noncoronary) 76380 CT limited or localized follow-up study 71275 CTA chest (noncoronary) 76942 71275 CTA chest (noncoronary) 76998 US guidance intra-operative 71275 CTA chest (noncoronary) 77001 29

71275 CTA chest (noncoronary) 77002 Fluoroscopic guidance for needle placement 71551 MRI chest, W contrast 71550 MRI chest, WO contrast 71551 MRI chest, W contrast 76000 Fluoroscopy, up to one hour physician time 71551 MRI chest, W contrast 76001 Fluoroscopy, more than one hour physician time 71551 MRI chest, W contrast 76942 71551 MRI chest, W contrast 76998 US guidance intra-operative 71551 MRI chest, W contrast 77001 71551 MRI chest, W contrast 77002 Fluoroscopic guidance for needle placement 71552 MRI Chest, WO & W contrast 71550 MRI chest, WO contrast 71552 MRI Chest, WO & W contrast 71551 MRI chest, W contrast 71552 MRI Chest, WO & W contrast 71555 MRA chest (excluding myocardium) W/WO contrast 71552 MRI Chest, WO & W contrast 76000 Fluoroscopy, up to one hour physician time 71552 MRI Chest, WO & W contrast 76001 Fluoroscopy, more than one hour physician time 71552 MRI Chest, WO & W contrast 76942 30

71552 MRI Chest, WO & W contrast 76998 US guidance intra-operative 71552 MRI Chest, WO & W contrast 77001 71552 MRI Chest, WO & W contrast 77002 Fluoroscopic guidance for needle placement 71555 MRA chest (excluding myocardium) W or WO contrast 71275 CTA chest (noncoronary) CPT Definition 71555 MRA chest (excluding myocardium) W or WO contrast 71550 MRI chest, WO contrast 71555 MRA chest (excluding myocardium) W or WO contrast 71551 MRI chest, W contrast 71555 MRA chest (excluding myocardium) W or WO contrast 76000 Fluoroscopy, up to one hour physician time 71555 MRA chest (excluding myocardium) W or WO contrast 76001 Fluoroscopy, more than one hour physician time 71555 MRA chest (excluding myocardium) W or WO contrast 76376 3D Rendering WO Postprocessing 71555 MRA chest (excluding myocardium) W or WO contrast 76377 3D Rendering W Postprocessing 71555 MRA chest (excluding myocardium) W or WO contrast 76942 71555 MRA chest (excluding myocardium) W or WO contrast 76998 US guidance intra-operative 71555 MRA chest (excluding myocardium) W or WO contrast 77001 71555 MRA chest (excluding myocardium) W or WO contrast 77002 Fluoroscopic guidance for needle placement 31

72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72020 X-ray, spine, single view, specify level 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72040 X-ray, cervical spine, 2 or 3 views 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72050 X-ray, cervical spine, min 4 views 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72052 Complete, including oblique & flex and/or extension studies 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72069 X-ray thoracolumbar spine, scoliosis 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72070 X-ray thoracic spine, 2 views 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72072 X-ray, thoracic spine, 3 views 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72074 X-ray, thoracic spine, min 4 views 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72080 Thoracolumbar 2 views 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72090 Scoliosis study, including supine and erect studies 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72100 X-ray, lumbosacral spine, 2 or 3 views 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72110 X-ray, lumbosacral spine, min 4 views 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72114 X-ray, lumbosacral spine, complete, including bending views 72010 X-ray, spine, entire, survey study, anteroposterior and lateral 72120 X-ray of the lumbar spine bending views only minimum of 4 views 32

72020 X-ray, spine, single view, specify level 77082 DEXA one or more sites, vertebral fracture assessment CPT Definition 72040 X-ray, cervical spine, 2 or 3 views 72020 X-ray, spine, single view, specify level CPT Definition 72050 X-ray, cervical spine, min 4 views 72020 X-ray, spine, single view, specify level 72050 X-ray, cervical spine, min 4 views 72040 X-ray, cervical spine, 2 or 3 views 72052 X-ray, spine, cervical, including oblique & flex and/or extension studies 72020 X-ray, spine, single view, specify level 72052 X-ray, spine, cervical, including oblique & flex and/or extension studies 72040 X-ray, cervical spine, 2 or 3 views 72052 X-ray, spine, cervical, including oblique & flex and/or extension studies 72050 X-ray, cervical spine, min 4 views 72069 X-ray, thoracolumbar spine, scoliosis 72020 X-ray, spine, single view, specify level CPT Definition 72069 X-ray, thoracolumbar spine, scoliosis 72090 Scoliosis study, including supine and erect studies 72070 X-ray, thoracic spine, 2 views 72020 X-ray, spine, single view, specify level CPT Definition 72070 X-ray, thoracic spine, 2 views 72090 Scoliosis study, including supine and erect studies 72072 X-ray, thoracic spine, 3 views 72020 X-ray, spine, single view, specify level CPT Definition 72072 X-ray, thoracic spine, 3 views 72070 X-ray thoracic spine, 2 views 72072 X-ray, thoracic spine, 3 views 72090 Scoliosis study, including supine and erect studies 33

72074 X-ray, thoracic spine, min 4 views 72020 X-ray, spine, single view, specify level CPT Definition 72074 X-ray, thoracic spine, min 4 views 72069 X-ray thoracolumbar spine, scoliosis 72074 X-ray, thoracic spine, min 4 views 72070 X-ray thoracic spine, 2 views 72074 X-ray, thoracic spine, min 4 views 72072 X-ray, thoracic spine, 3 views 72074 X-ray, thoracic spine, min 4 views 72090 Scoliosis study, including supine and erect studies 72080 X-ray, thoracolumbar spine, 2 views 72020 X-ray, spine, single view, specify level CPT Definition 72080 X-ray, thoracolumbar spine, 2 views 72069 X-ray thoracolumbar spine, scoliosis 72080 X-ray, thoracolumbar spine, 2 views 72070 X-ray thoracic spine, 2 views 72080 X-ray, thoracolumbar spine, 2 views 72072 X-ray, thoracic spine, 3 views 72080 X-ray, thoracolumbar spine, 2 views 72074 X-ray, thoracic spine, min 4 views 72090 Scoliosis study, including supine and erect studies 72020 X-ray, spine, single view, specify level CPT Definition 72090 Scoliosis study, including supine and erect studies 72080 X-ray, thoracolumbar spine, 2 views 72100 X-ray, lumbosacral spine, 2 or 3 views 72020 X-ray, spine, single view, specify level CPT Definition 72110 X-ray, lumbosacral spine, min 4 views 72020 X-ray, spine, single view, specify level 34

72110 X-ray, lumbosacral spine, min 4 views 72100 X-ray, lumbosacral spine, 2 or 3 views 72110 X-ray, lumbosacral spine, min 4 views 72114 X-ray, lumbosacral spine, complete, including bending views 72114 X-ray, lumbosacral spine, complete, including bending views 72020 X-ray, spine, single view, specify level CPT Definition 72114 X-ray, lumbosacral spine, complete, including bending views 72100 X-ray, lumbosacral spine, 2 or 3 views 72114 X-ray, lumbosacral spine, complete, including bending views 72120 X-ray of the lumbar spine bending views only minimum of 4 views 72120 X-ray of the lumbar spine bending views only minimum of 4 views 72100 X-ray, lumbosacral spine, 2 or 3 views CPT Definition 72120 X-ray of the lumbar spine bending views only minimum of 4 views 72110 X-ray, lumbosacral spine, min 4 views 72125 CT cervical spine WO contrast 72020 X-ray, spine, single view, specify level CPT Definition 72125 CT cervical spine WO contrast 72040 X-ray, cervical spine, 2 or 3 views CPT Definition 72125 CT cervical spine WO contrast 72050 X-ray, cervical spine, min 4 views CPT Definition 72125 CT cervical spine WO contrast 72052 Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies CPT Definition 72125 CT cervical spine WO contrast 72240 Myelography, cervical, radiological supervision and CPT Definition 72125 CT cervical spine WO contrast 76380 CT limited or localized follow-up study 72126 CT cervical spine W contrast 72020 Radiologic examination, spine, single view, specify level CPT Definition 35

72126 CT cervical spine W contrast 72040 X-ray, cervical spine, 2 or 3 views CPT Definition 72126 CT cervical spine W contrast 72050 X-ray, cervical spine, min 4 views CPT Definition 72126 CT cervical spine W contrast 72052 Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies CPT Definition 72126 CT cervical spine W contrast 72125 CT cervical spine WO contrast 72126 CT cervical spine W contrast 72240 Myelography, cervical, radiological supervision and CPT Definition 72126 CT cervical spine W contrast 76000 Fluoroscopy, up to one hour physician time 72126 CT cervical spine W contrast 76001 Fluoroscopy, more than one hour physician time 72126 CT cervical spine W contrast 76380 CT limited or localized follow-up study 72126 CT cervical spine W contrast 76942 72126 CT cervical spine W contrast 76998 US guidance intra-operative 72126 CT cervical spine W contrast 77001 72126 CT cervical spine W contrast 77002 Fluoroscopic guidance for needle placement 72127 CT cervical spine WO & W contrast 72040 X-ray, cervical spine, 2 or 3 views CPT Definition 72127 CT cervical spine WO & W contrast 72125 CT cervical spine WO contrast 36

72127 CT cervical spine WO & W contrast 72126 CT cervical spine W contrast 72127 CT cervical spine WO & W contrast 76000 Fluoroscopy, up to one hour physician time 72127 CT cervical spine WO & W contrast 76001 Fluoroscopy, more than one hour physician time 72127 CT cervical spine WO & W contrast 76380 CT limited or localized follow-up study 72127 CT cervical spine WO & W contrast 76942 72127 CT cervical spine WO & W contrast 76998 US guidance intra-operative 72127 CT cervical spine WO & W contrast 77001 72127 CT cervical spine WO & W contrast 77002 Fluoroscopic guidance for needle placement 72128 CT thoracic spine WO contrast 72070 X-ray thoracic spine, 2 views CPT Definition 72128 CT thoracic spine WO contrast 72072 X-ray, thoracic spine, 3 views CPT Definition 72128 CT thoracic spine WO contrast 72074 X-ray, thoracic spine, min 4 views CPT Definition 72128 CT thoracic spine WO contrast 72080 Thoracolumbar 2 views CPT Definition 72128 CT thoracic spine WO contrast 72255 Myelography, thoracic, radiological supervision and CPT Definition 72128 CT thoracic spine WO contrast 72292 CT guidance percutaneous vertebroplasty 37

72128 CT thoracic spine WO contrast 76380 CT limited or localized follow-up study 72129 CT thoracic spine W contrast 72070 X-ray thoracic spine, 2 views CPT Definition 72129 CT thoracic spine W contrast 72072 X-ray, thoracic spine, 3 views CPT Definition 72129 CT thoracic spine W contrast 72074 X-ray, thoracic spine, min 4 views CPT Definition 72129 CT thoracic spine W contrast 72080 Thoracolumbar 2 views CPT Definition 72129 CT thoracic spine W contrast 72128 CT thoracic spine WO contrast 72129 CT thoracic spine W contrast 72255 Myelography, thoracic, radiological supervision and CPT Definition 72129 CT thoracic spine W contrast 72292 CT guidance percutaneous vertebroplasty 72129 CT thoracic spine W contrast 76000 Fluoroscopy, up to one hour physician time 72129 CT thoracic spine W contrast 76001 Fluoroscopy, more than one hour physician time 72129 CT thoracic spine W contrast 76380 CT limited or localized follow-up study 72129 CT thoracic spine W contrast 76942 72129 CT thoracic spine W contrast 76998 US guidance intra-operative 72129 CT thoracic spine W contrast 77001 38

72129 CT thoracic spine W contrast 77002 Fluoroscopic guidance for needle placement 72130 CT thoracic spine WO & W contrast 72070 X-ray thoracic spine, 2 views CPT Definition 72130 CT thoracic spine WO & W contrast 72072 X-ray, thoracic spine, 3 views CPT Definition 72130 CT thoracic spine WO & W contrast 72074 X-ray, thoracic spine, min 4 views CPT Definition 72130 CT thoracic spine WO & W contrast 72080 Thoracolumbar 2 views CPT Definition 72130 CT thoracic spine WO & W contrast 72128 CT thoracic spine WO contrast 72130 CT thoracic spine WO & W contrast 72129 CT thoracic spine W contrast 72130 CT thoracic spine WO & W contrast 72292 CT guidance percutaneous vertebroplasty 72130 CT thoracic spine WO & W contrast 76000 Fluoroscopy, up to one hour physician time 72130 CT thoracic spine WO & W contrast 76001 Fluoroscopy, more than one hour physician time 72130 CT thoracic spine WO & W contrast 76380 CT limited or localized follow-up study 72130 CT thoracic spine WO & W contrast 76942 72130 CT thoracic spine WO & W contrast 76998 US guidance intra-operative 72130 CT thoracic spine WO & W contrast 77001 39