Summary & Overview
CPT 71047: Chest X-Ray, Three Views
CPT code 71047 is a nationally recognized billing code for radiologic examination of the chest with three views, a standard diagnostic procedure in medical imaging. This code is essential for evaluating a variety of chest conditions, including respiratory illnesses, cardiac issues, and other abnormalities. The procedure is performed in both hospital outpatient and office settings, making it widely accessible across healthcare environments.
Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Understanding coverage policies and reimbursement benchmarks for these payers is crucial for providers and administrators seeking to optimize billing practices and ensure compliance.
This publication provides a comprehensive overview of CPT 71047, including its clinical context, typical sites of service, and payer coverage. Readers will gain insights into current policy updates, utilization trends, and relevant benchmarks for chest radiology services. The analysis also highlights common billing modifiers and associated clinical diagnoses, offering a clear picture of how this code is used in practice. The information is designed to support healthcare professionals, billing specialists, and policy analysts in navigating the complexities of diagnostic radiology billing and coverage.
CPT Code Overview
CPT 71047 represents a radiologic examination of the chest with three views. This diagnostic imaging procedure is commonly used to assess conditions affecting the lungs, heart, and chest wall. The service falls under Radiology – Diagnostic Radiology (Chest Imaging) and is typically performed in a hospital outpatient setting (POS 22) or an office setting (POS 11), depending on clinical and operational factors. This code is integral to the evaluation of a wide range of chest-related symptoms and diseases, supporting timely diagnosis and management in both acute and chronic care scenarios.
Clinical & Coding Specifications
Clinical Context
A patient presents to the hospital outpatient department or physician office with symptoms such as cough, chest pain, shortness of breath, or abnormal findings on a prior exam. The clinician orders a chest radiologic examination with 3 views (CPT 71047) to evaluate for conditions like pneumonia, chronic obstructive pulmonary disease (COPD) exacerbation, asthma, or to investigate nonspecific abnormal findings. The workflow involves the radiologic technologist performing the imaging, followed by a radiologist interpreting the results and documenting the findings for clinical management.
Coding Specifications
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Modifiers:
26– Professional Component: Used when only the interpretation and report of the radiologic exam is performed, typically by the radiologist.TC– Technical Component: Used when only the technical aspect (equipment, supplies, and technician) is provided, usually by the facility.59– Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day.
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Provider Taxonomies:
Code Specialty Name 208B00000XDiagnostic Radiology 2085R0201XRadiology – Diagnostic Radiology
These taxonomies represent providers specializing in diagnostic radiology, including radiologists and facilities offering radiologic imaging services.
Related Diagnoses
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J18.9– Pneumonia, unspecified organism- Relevant for patients with suspected or confirmed pneumonia, where chest imaging helps identify infiltrates or consolidation.
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R91.8– Other nonspecific abnormal finding of lung field- Used when prior imaging or clinical assessment reveals abnormal findings requiring further evaluation with chest radiographs.
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J44.1– Chronic obstructive pulmonary disease with (acute) exacerbation- Applied for patients with COPD experiencing acute symptoms; chest imaging assists in ruling out complications or alternative diagnoses.
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R07.9– Chest pain, unspecified- Used for patients presenting with chest pain, where imaging is necessary to exclude pulmonary causes.
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J45.909– Unspecified asthma, uncomplicated- Relevant for asthma patients with respiratory symptoms, to assess for complications or exclude other pulmonary pathology.
Related CPT Codes
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71045– Radiologic examination, chest; single view- Used when only one view of the chest is required, often for initial screening or follow-up of a known abnormality.
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71046– Radiologic examination, chest; 2 views- Used for a standard two-view chest x-ray, commonly ordered for routine evaluation of chest symptoms.
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71048– Radiologic examination, chest; 4 or more views- Used when a more comprehensive assessment is needed, such as for complex cases or when additional views are necessary to clarify findings.
CPT 71047 (3 views) is typically ordered when more detail is needed than a single or two-view exam, but less than four or more views. These codes are alternatives based on clinical need and are not commonly billed together for the same encounter.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 71047 is highest among commercial payers, with Cigna at $43.35 and Blue Cross Blue Shield at $40.46. The average commercial benchmark (BUCA) stands at $37.21, notably higher than the Medicare mean rate of $28.50. This highlights a significant gap between commercial and government reimbursement levels for this service.
Rate dispersion varies across payers. Medicare shows the widest spread, with a difference of $27.00 between its 75th and 25th percentiles, indicating substantial variability in payment rates. In contrast, Aetna has the tightest range at $8.67, suggesting more consistent reimbursement. Cigna and Blue Cross Blue Shield also exhibit broad ranges, reflecting greater variability in commercial payments.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
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