Summary & Overview
CPT 70470: CT Scan of Head or Brain with and without Contrast
CPT code 70470 is a widely used billing code for computed tomography (CT) scans of the head or brain, performed first without contrast and then with contrast material. This diagnostic imaging procedure is essential for evaluating a range of neurological conditions, including trauma, stroke, and unexplained headaches. The code is recognized by major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage across the United States.
This publication provides a comprehensive overview of 70470, including its clinical applications, typical sites of service, and payer coverage. Readers will gain insight into the procedure's role in modern diagnostic radiology, learn about common billing practices, and understand the importance of accurate coding for reimbursement and compliance. The analysis also highlights associated modifiers, relevant taxonomies, and ICD-10 diagnoses frequently linked to this code, offering a clear picture of its place in clinical workflows and payer policies. Benchmarks and policy updates are discussed to inform stakeholders about current trends and requirements in medical billing for CT head scans.
By examining 70470 in detail, this article equips healthcare professionals, administrators, and policy analysts with the knowledge needed to navigate the complexities of diagnostic imaging billing and coverage.
CPT Code Overview
CPT code 70470 represents a computed tomography (CT) scan of the head or brain performed without contrast material, followed by contrast material(s) and additional imaging sections. This procedure is classified under diagnostic radiology (diagnostic imaging) and is commonly utilized to evaluate neurological conditions, trauma, or other abnormalities within the cranial region. Typical sites of service for this procedure include outpatient hospital settings and office locations, often designated as POS 11 or POS 22. The CT scan provides detailed cross-sectional images, aiding clinicians in diagnosis and treatment planning.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital or office with symptoms such as sudden severe headache, confusion, loss of consciousness, or neurological deficits. The clinician suspects a possible intracranial pathology, such as hemorrhage, infarction, or other brain disorder. To evaluate the brain, a computed tomography (CT) scan of the head is ordered. The procedure involves an initial scan without contrast, followed by administration of contrast material and further imaging sections. This workflow allows for assessment of both non-contrast and contrast-enhanced views, aiding in diagnosis of conditions like traumatic subdural hemorrhage, cerebral infarction, or other brain disorders.
Coding Specifications
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Modifier
26: Used when reporting only the professional component (interpretation and report) of the CT scan. -
Modifier
TC: Used when reporting only the technical component (equipment, supplies, and technician) of the CT scan. -
Modifier
59: Used to indicate a distinct procedural service, typically when multiple procedures are performed and need to be reported separately.
| Taxonomy Code | Specialty Name |
|---|---|
2085R0204X | Diagnostic Radiology |
2084P0802X | Neurology |
Related Diagnoses
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S06.5X9A: Traumatic subdural hemorrhage, unspecified, initial encounter- Relevant for patients with head trauma and suspected intracranial bleeding, where CT imaging is essential for diagnosis.
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G93.9: Disorder of brain, unspecified- Used when a patient presents with neurological symptoms and the underlying cause is unclear, warranting CT evaluation.
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R51: Headache- CT imaging may be ordered to rule out structural causes of headache, such as hemorrhage or mass.
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I63.9: Cerebral infarction, unspecified- CT scans are critical in the assessment of suspected stroke or infarction.
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R55: Syncope and collapse- When a patient experiences unexplained loss of consciousness, CT imaging helps exclude intracranial pathology.
Related CPT Codes
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70460: Computed tomography, head or brain; without contrast material- This code is used when only non-contrast CT imaging of the head or brain is performed. It is an alternative to
70470when contrast is not administered.
- This code is used when only non-contrast CT imaging of the head or brain is performed. It is an alternative to
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70480: Computed tomography, orbit, sella, or posterior fossa; without contrast material- This code is used for CT imaging of specific regions such as the orbit, sella, or posterior fossa without contrast. It may be used in conjunction with
70470if additional anatomical regions require evaluation, or as an alternative when the clinical indication is limited to these areas.
- This code is used for CT imaging of specific regions such as the orbit, sella, or posterior fossa without contrast. It may be used in conjunction with
National Reimbursement Benchmarks
National mean rates for CPT code 70470 show a significant gap between Medicare and commercial payers. Medicare's mean rate is $119.99, while the BUCA (average commercial) mean rate is $184.13, highlighting a difference of $64.14 per service.
Rate dispersion varies across payers. Aetna has the tightest spread, with a difference of $60.75 between its 75th and 25th percentiles. Cigna exhibits the widest dispersion, with a $132.33 gap between its 75th and 25th percentiles. Blue Cross Blue Shield, UnitedHealth Group, and BUCA also show substantial ranges, indicating variability in contracted rates.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
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