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Empire BlueCross BlueShield
Diagnostic Imaging and Cardiology Program and Enhanced Cardiology: cardiac catheterization, arterial
ultrasound, and percutaneous coronary intervention (PCI) CPT® Code List
Computerized Tomography (CT)
Abdomen
Chest
Upper Extremity
Lower Extremity
Head
Orbit
CPT
74150
74160
74170
71250
71260
71270
73200
73201
73202
73700
73701
73702
70450
70460
70470
70480
70481
Description
CT abdomen; w/o contrast
CT abdomen; with contrast
CT abdomen; w/o contrast followed by contrast
CT thorax; w/o contrast
CT thorax; with contrast
CT thorax; w/o contrast followed by contrast
CT upper extremity; w/o contrast
CT upper extremity; with contrast
CT upper extremity; w/o contrast followed by contrast
CT lower extremity; w/o contrast
CT lower extremity; with contrast
CT lower extremity; w/o contrast followed by contrast
CT head or brain; w/o contrast
CT head or brain; with contrast
CT head or brain; w/o contrast followed by contrast
CT orbit, sella or posterior fossa; w/o contrast
CT orbit, sella or posterior fossa; with contrast
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue
Cross and Blue Shield plans.
70482
Sinus
Neck
Pelvis
Cervical Spine
Thoracic Spine
Lumbar Spine
Abdomen and Pelvis
70486
70487
70488
70490
70491
70492
72192
72193
72194
72125
72126
72127
72128
72129
72130
72131
72132
72133
74176
74177
74178
Computerized Tomography Angiography (CTA)
CPT
Abdomen
74175
75635
CT orbit, sella or posterior fossa; w/o contrast followed by contrast
CT maxillofacial area; w/o contrast
CT maxillofacial area; with contrast
CT maxillofacial area; w/o contrast followed by contrast
CT soft tissue neck; w/o contrast
CT soft tissue neck; with contrast
CT soft tissue neck; w/o contrast followed by contrast
CT pelvis; w/o contrast
CT pelvis; with contrast
CT pelvis w/o contrast followed by contrast
CT cervical spine; w/o contrast
CT cervical spine; with contrast
CT cervical spine; w/o contrast followed by contrast
CT thoracic spine; w/o contrast
CT thoracic spine; with contrast
CT thoracic spine; w/o contrast followed by contrast
CT lumbar spine; w/o contrast
CT lumbar spine; with contrast
CT lumbar spine; w/o contrast followed by contrast
CT abdomen and pelvis; w/o contrast
CT abdomen and pelvis; with contrast
CT abdomen and pelvis; w/o contrast followed by contrast
Description
CTA abdomen
CTA abdominal aorta & bilateral iliofemoral lower extremity runoff
Abdomen and Pelvis
Chest
Upper Extremity
Lower Extremity
Head
Neck
74174
71275
73206
73706
70496
70498
Pelvis
72191
Magnetic Resonance Imaging (MRI)
CPT
74181
74182
74183
77084
77058
77059
71550
71551
71552
Abdomen
Bone Marrow
Breast
Chest
75557
75559
Cardiac
CTA abdomen & pelvis wo/w contrast
CTA chest
CTA upper extremity
CTA lower extremity
CTA head
CTA neck
CTA pelvis
Description
MRI abdomen; w/o contrast
MRI abdomen; with contrast
MRI abdomen; w/o contrast followed by contrast
MRI bone marrow blood supply
MRI breast; unilateral
MRI breast; bilateral
MRI chest; w/o contrast
MRI chest; with contrast
MRI chest; w/o contrast followed by contrast
MRI Cardiac for morphology and function without contrast material;
MRI Cardiac for morphology and function without contrast material; with stress imaging
75561
MRI Cardiac for morphology and function without contrast material(s), followed by
contrast material(s) and further sequences;
75563
MRI Cardiac for morphology and function without contrast material(s), followed by
contrast material(s) and further sequences; with stress imaging
Upper Extremity Non-joint
73218
73219
73220
Upper Extremity Any Joint
73221
73222
73223
73718
73719
Lower Extremity
73720
73721
73722
73723
TMJ
Orbit
Brain
Pelvis
Cervical Spine
70336
70540
70542
70543
70551
70552
70553
72195
72196
72197
72141
72142
MRI upper extremity, other than joint w/o contrast
MRI upper extremity, other than joint with contrast
MRI upper extremity, other than joint w/o contrast followed by contrast
MRI upper extremity, any joint w/o contrast
MRI upper extremity, any joint with contrast
MRI upper extremity, any joint w/o contrast followed by contrast
MRI lower extremity, other than joint w/o contrast
MRI lower extremity, other than joint w contrast
MRI lower extremity, other than joint w/o contrast followed by contrast
MRI lower extremity, any joint w/o contrast
MRI lower extremity, any joint w contrast
MRI lower extremity, any joint w/o contrast followed by contrast
MRI temporomandibular joint(s)
MRI orbit, face and neck; w/o contrast
MRI orbit, face and neck; with contrast
MRI orbit, face and neck; w/o contrast followed by contrast
MRI brain; w/o contrast
MRI brain; with contrast
MRI brain; w/o contrast followed by contrast
MRI pelvis; w/o contrast
MRI pelvis; with contrast
MRI pelvis; w/o contrast followed by contrast
MRI cervical spine; w/o contrast
MRI cervical spine; with contrast
72156
72146
72147
72157
72148
72149
72158
Thoracic Spine
Lumbar Spine
Magnetic Resonance Angiography (MRA)
CPT
Abdomen
Chest
Upper Extremity
Lower Extremity
74185
71555
73225
73725
70544
70545
70546
70547
70548
70549
72198
72159
Head
Neck
Pelvis
Spinal Canal
Magnetic Resonance Spectroscopy
(MRS)
CPT
76390
QCT Bone Densitometry
CPT
77078
MRI cervical spine; w/o contrast followed by contrast
MRI thoracic spine; w/o contrast
MRI thoracic spine; with contrast
MRI thoracic spine; w/o contrast followed by contrast
MRI lumbar spine; w/o contrast
MRI lumbar spine; with contrast
MRI lumbar spine; w/o contrast followed by contrast
Description
MRA abdomen; with or w/o contrast
MRA chest; with or w/o contrast
MRA upper extremity; with or w/o contrast
MRA lower extremity; with or w/o contrast
MRA head; w/o contrast
MRA head; with contrast
MRA head; w/o contrast followed by contrast
MRA neck; w/o contrast
MRA neck; with contrast
MRA neck; w/o contrast followed by contrast
MRA pelvis; with or w/o contrast
MRA spinal canal and contents with or w/o contrast
Description
MR Spectroscopy
Description
CT bone mineral density study; axial skeleton
Nuclear Cardiology
CPT
78451
Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction,
qualitative or quantitative wall motion, ejection fraction by first pass or gated technique,
additional quantification, when performed); single study, at rest or stress (exercise or
pharmacologic)
78452
Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction,
qualitative or quantitative wall motion, ejection fraction by first pass or gated technique,
additional quantification, when performed); multiple studies, at rest and/or stress
reinjection
78453
Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion,
ejection fraction by first pass or gated technique, additional quantification, when
performed); single study, at rest or stress (exercise or pharmacologic)
78454
Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion,
ejection fraction by first pass or gated technique, additional quantification, when
performed); multiple studies, at rest and/or stress (exercise or pharmacologic)
Myocardial Perfusion Imaging
78466
Infarct Imaging
78468
78469
Cardiac Blood Pool Imaging
Description
78472
78473
Planar, infarct avid; qualitative or quantitative
Planar, infarct avid; with ejection fraction by first pass technique
SPECT, infarct avid; with or w/o quantification
Gated equilibrium; planar, single study, wall motion plus ejection fraction
Gated equilibrium; planar, multiple studies, wall motion study plus ejection fraction
78481
78483
78494
Positron Emission Tomography (PET)
First pass tech; single study, wall motion study plus ejection fraction
First pass tech; multiple studies, wall motion study plus ejection fraction
Gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction
CPT
78608
78609
78459
78491
78492
Description
PET brain, metabolic evaluation
PET brain, perfusion evaluation
PET myocardial, metabolic evaluation
PET myocardial, perfusion, single study
PET myocardial, perfusion, multiple studies
PET and PET/CT Fusion
CPT
78811
78812
78813
78814
78815
78816
Description
PET imaging, limited
PET imaging, skull to mid-thigh
PET imaging, whole body
PET imaging with concurrent CT, limited
PET imaging with concurrent CT, skull to mid-thigh
PET imaging with concurrent CT, whole body
Screening CT Colonoscopy
CPT
Brain Imaging
Myocardial Imaging
74263
Diagnostic CT Colonography
CPT
Description
Computed tomographic (CT) colonography, screening, including image post processing
Description
74261
Computed tomographic (CT) colonography, diagnostic, including image post processing;
without contrast material
74262
Computed tomographic (CT) colonography, diagnostic, including image post processing;
with contrast material(s) including non-contrast images, if performed
Functional MRI Brain
CPT
70554
70555
CT Heart for Calcium Scoring
CPT
75571
CT Heart for Structure & Morph
CTA Heart Incl Structure & Morph
CPT
Description
Functional MRI brain not requiring physician administration
Functional MRI brain requiring physician administration
Description
Computed tomography, heart, without contrast material, with quantitative evaluation of
coronary calcium
Description
75572
Computed tomography, heart, with contrast material, for evaluation of cardiac structure
and morphology (including 3D image post processing, assessment of cardiac function,
and evaluation of venous structures, if performed)
75573
Computed tomography, heart, with contrast material, for evaluation of cardiac structure
and morphology in the setting of congenital heart disease (including 3D image post
processing, assessment of LV cardiac function, RV structure and function and evaluation
of venous structures, if performed)
CPT
75574
Add-on Procedures
CPT
CT or MRI Grouping
76376 &
76377
Description
Computed tomographic angiography, heart, coronary arteries and bypass grafts (when
present), with contrast material, including 3D image post processing (including evaluation
of cardiac structure and morphology, assessment of cardiac function, and evaluation of
venous structures if performed)
Description
3 D Reconstruction of CT or MRI images
Cardiac MRI Grouping
75565
Cardiac Blood Pool Grouping
Group 82 valid with code 78472 only
78496
Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition
to code for primary procedure)
MRI Fetal
74713
CT Grouping
76380
Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular
ejection fraction by first pass technique (Add-on to 78472 only)
Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic
imaging when performed; each additional gestation (List separately in addition to code for
primary procedure 74712)
Limited follow-up CT
CPT
Description
93350
Transthoracic Stress Echo, complete
93351
Transthoracic Stress Echo, complete w cont EKG
93303
Transthoracic Echo cardiac anomalies
93304
Transthoracic Echo cardiac anomalies, limited
93306
Transthoracic Echo complete w color & spectral
93307
Transthoracic Echo complete wo color & spectral
93308
Transthoracic Echo limited
93312
Transesophageal Echo
93313
Transesophageal Echo probe only
93314
Transesophageal Echo interpretation
93315
Transesophageal Echo congenital
93316
Transesophageal Echo congenital, probe only
93317
Transesophageal Echo congenital interpretation
CPT
Description
93320
Doppler Echo complete
93321
Doppler Echo limited
93325
Doppler Echo flow velocity
Echocardiogram
Stress Echo (SE)
Resting Trans Echo (TTE)
Transesophageal Echo (TEE)
Echo Add-On Codes
93352
Echo contrast agent (SE only)
The codes listed below are effective March 1, 2016
RT and/or LT Heart Cath with Coronary Angiography
CPT
93456
93457
93458
93459
93460
93461
Add-On Codes (Note: Add-On Codes do not require an
authorization.)
RT and/or LT Heart Cath with Coronary Angiography
Duplex Scan Aorta, IVC & Iliac Vessels
CPT
Description
CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
R & L HRT CATH WINJX HRT ART& L VENTR IMG
R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
Description
93462
93463
LEFT HEART CATH BY TRANSEPTAL PUNCTURE
MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
93464
PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU
93566
93567
93568
CPT
NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I
NJX SUPRAVALV AORTOG HRT CATH W/S&I
NJX PULMONARY ANGIO HRT CATH W/S&I
Description
93978
DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE
93979
DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD
Duplex Scan Extracranial Arteries
NIV Physiologic Studies Extremity Arteries
Duplex Scan Lower Extremity Arteries
Duplex Scan Upper Extremity Arteries
Percutaneous Coronary Intervention (PCI)
CPT
93880
Description
DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY
93882
DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY
CPT
Description
93922
NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL
93923
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS
93924
CPT
93925
93926
CPT
93930
93931
CPT
92920
92924
92928
92933
92937
N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI
Description
DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
Description
DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
Description
PRQ CARDIAC ANGIOPLAST 1 ART
PRQ CARD ANGIO/ATHRECT 1 ART
PRQ CARD STENT W/ANGIO 1 VSL
PRQ CARD STENT/ATH/ANGIO
PRQ REVASC BYP GRAFT 1 VSL
PRQ CARD REVASC CHRONIC 1VSL
92943
Add-On Codes (Note: Add-On Codes do not require an
authorization)
Percutaneous Coronary
Intervention (PCI)
Coronary Angiography
Add-On Codes (Note: Add-On Codes do not require an
authorization.)
Coronary Angiography
CPT
92921
PRQ CARDIAC ANGIO ADDL ART
92925
92929
92934
92938
92944
CPT
PRQ CARD ANGIO/ATHRECT ADDL
PRQ CARD STENT W/ANGIO ADDL
PRQ CARD STENT/ATH/ANGIO
PRQ REVASC BYP GRAFT ADDL
PRQ CARD REVASC CHRONIC ADDL
Description
93454
CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
93455
CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
CPT
93567
RT and/or LT Heart Cath without Coronary
Angiography
Description
CPT
Description
NJX SUPRAVALV AORTOG HRT CATH W/S&I
Description
93451
RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
93452
93453
93530
L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
RT HEART CATH CONGENITAL
Add-On Codes (Note: Add-On Codes do not require an
authorization.)
RT
and/or LT Heart Cath without Coronary Angiography
93531
93532
R & L HEART CATH CONGENITAL
R & L HEART CATH CONGENITAL
93533
R & L HEART CATH CONGENITAL
CPT
Description
93462
93463
LEFT HEART CATH BY TRANSEPTAL PUNCTURE
MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
93464
PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU
93566
93567
93568
93563
93564
NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I
NJX SUPRAVALV AORTOG HRT CATH W/S&I
NJX PULMONARY ANGIO HRT CATH W/S&I
INJECT CONGENITAL CARD CATH
INJECT HRT CONGNTL ART/GRFT
93565
INJECT L VENTR/ATRIAL ANGIO