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Download Radiology CPT code list
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PLEASE NOTE: This list is subject to change. CPT codes are deleted and added each year by the American Medical Association (AMA). It is the responsibility of each practitioner to be aware of these coding changes. The health plan is not responsible to provide updates to this list as codes are periodically added and deleted by the AMA. CPT CODE PROCEDURE DESCRIPTION RADIOLOGY STUDIES CT SCANS: 70450 CT HEAD/BRAIN W/O CONTRAST 70460 CT HEAD/BRAIN W/ CONTRAST 70470 CT HEAD/BRAIN W/O & W/ CONTRAST 70480 CT ORBIT W/O CONTRAST 70481 CT ORBIT W/ CONTRAST 70482 CT ORBIT W/O & W/ CONTRAST 70486 CT MAXLLFCL W/O CONTRAST 70487 CT MAXLLFCL W/ CONTRAST 70488 CT MAXLLFCL W/O & W/ CONTRAST 70490 CT SOFT TISSUE NECK W/O CONTRAST 70491 CT SOFT TISSUE NECK W/ CONTRAST 70492 CT SOFT TISSUE NECK W/O & W/ CONTRAST 70496 CT ANGIOGRAPHY HEAD 70498 CT ANGIOGRAPHY NECK 71250 CT THORAX W/O CONTRAST 71260 CT THORAX W/ CONTRAST 71270 CT THORAX W/O & W/ CONTRAST 71275 CT ANGIOGRAPHY CHEST, NON-CORONARY 72125 CT C SPINE W/O CONTRAST 72126 CT C SPINE W/ CONTRAST 72127 CT C SPINE W/O & W/ CONTRAST 72128 CT T SPINE W/O CONTRAST 72129 CT T SPINE W/ CONTRAST 72130 CT T SPINE W/O & W/ CONTRAST 72131 CT L SPINE W/O CONTRAST 72132 CT L SPINE W/ CONTRAST 72133 CT L SPINE W/O & W/ CONTRAST 72192 CT PELVIS W/O CONTRAST 72193 CT PELVIS W/ CONTRAST 72194 CT PELVIS W/O & W/ CONTRAST 73200 CT UPPER EXTREMITY W/O CONTRAST 73201 CT UPPER EXTREMITY W/ CONTRAST 73202 CT UPPER EXTREMITY W/O & W/ CONTRAST 73700 CT LOWER EXTREMITY W/O CONTRAST 73701 CT LOWER EXTREMITY W/ CONTRAST eviCore healthcare CPT Code List September 22, 2015 PLEASE NOTE: This list is subject to change. CPT codes are deleted and added each year by the American Medical Association (AMA). It is the responsibility of each practitioner to be aware of these coding changes. The health plan is not responsible to provide updates to this list as codes are periodically added and deleted by the AMA. 73702 74150 74160 74170 74176 74177 74178 74261 74262 74263 75571 75572 CT LOWER EXTREMITY W/O & W/ CONTRAST CT ABDOMEN W/O CONTRAST CT ABDOMEN W/ CONTRAST CT ABDOMEN W/O & W/ CONTRAST CT ABDOMEN & PELVIS W/O CONTRAST CT ABDOMEN & PELVIS W/CONTRAST CT ABDOMEN & PELVIS W/O CONTRAST FOLLOWED BY W/ CONTRAST COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITHOUT CONTRAST MATERIAL COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITH CONTRAST MATERIAL(S) INCLUDING NON-CONTRAST IMAGES, IF PERFORMED COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, SCREENING, INCLUDING IMAGE POSTPROCESSING CT HEART WITHOUT CONTRAST MATERIAL, WITH QUANTITATIVE EVALUATION OF CORONARY CALCIUM COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY (INCLUDING 3D IMAGE POSTPROCESSING, 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 POSTPROCESSING, ASSESSMENT OF LV CARDIAC FUNCTION, RV STRUCTURE AND FUNCTION AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) 75574 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEART, CORONARY ARTERIES AND BYPASS GRAFTS (WHEN PRESENT), WITH CONTRAST MATERIAL, INCLUDING 3D IMAGE POSTPROCESSING (INCLUDING EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) 76497 UNLISTED COMPUTED TOMOGRAPHY PROCEDURE CEREBRAL PERFUSION ANALYSIS USING CT WITH CONTRAST (**only in the outpatient/office setting) S8032 LOW-DOSE COMPUTED TOMOGRAPHY FOR LUNG CANCER SCREENING MR SCANS: 70336 MRI TMJ 70540 MRI FACE, ORBIT, AND/OR NECK W/O CONTRAST 70542 MRI FACE, ORBIT, AND/OR NECK W/ CONTRAST 70543 MRI FACE, ORBIT, AND/OR NECK W & W/O CONTRAST 70544 MRA HEAD W/O CONTRAST 70545 MRA HEAD W/ CONTRAST 70546 MRA HEAD W & W/O CONTRAST 0042T eviCore healthcare CPT Code List September 22, 2015 PLEASE NOTE: This list is subject to change. CPT codes are deleted and added each year by the American Medical Association (AMA). It is the responsibility of each practitioner to be aware of these coding changes. The health plan is not responsible to provide updates to this list as codes are periodically added and deleted by the AMA. 70547 70548 70549 70551 70552 70553 70554 70555 71550 71551 71552 71555 72141 72142 72146 72147 72148 72149 72156 72157 72158 72195 72196 72197 73218 73219 73220 73221 73222 73223 73718 73719 73720 73721 73722 73723 74181 74182 74183 MRA NECK W/O CONTRAST MRA NECK W CONTRAST MRA NECK W & W/O CONTRAST MRI BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MRI BRAIN (INCLUDING BRAIN STEM); WITH CONTRAST MRI BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST, FOLLOWED BY WITH CONTRAST FUNCTIONAL MRI BRAIN BY TECH FUNCTIONAL MRI BRAIN BY PHYS/PSYCH MRI CHEST W/O CONTRAST MRI CHEST W CONTRAST MRI CHEST W & W/O CONTRAST MRA CHEST (EXC MYOCARDIUM) W/ OR W/O CONTRAST MRI CERVICAL SPINE W/O CONTRAST MRI CERVICAL SPINE W/ CONTRAST MRI THORACIC SPINE W/O CONTRAST MRI THORACIC SPINE W/ CONTRAST MRI LUMBAR SPINE W/O CONTRAST MRI LUMBAR SPINE W/ CONTRAST MRI C SPINE W/ & W/O CONTRAST MRI T SPINE W/ & W/O CONTRAST MRI L SPINE W/ & W/O CONTRAST MRI PELVIS W/O CONTRAST MRI PELVIS W CONTRAST MRI PELVIS W & W/O CONTRAST MRI UPPER EXTREMITY OTHER THAN JOINT, WITHOUT CONTRAST MRI UPPER EXTREMITY OTHER THAN JOINT, WITH CONTRAST MRI UPPER EXTREMITY OTHER THAN JOINT, WITH AND WITHOUT CONTRAST MRI UPPER EXTREMITY JOINT W/O CONTRAST MRI UPPER EXTREMITY JOINT W CONTRAST MRI UPPER EXTREMITY JOINT W & W/O CONTRAST MRI LOWER EXTREMITY OTHER THAN JOINT, WITHOUT CONTRAST MRI LOWER EXTREMITY OTHER THAN JOINT, WITH CONTRAST MRI LOWER EXTREMITY OTHER THAN JOINT, WITH AND WITHOUT CONTRAST MRI LOWER EXTREMITY JOINT W/O CONTRAST MRI LOWER EXTREMITY JOINT W CONTRAST MRI LOWER EXTREMITY JOINT W & W/O CONTRAST MRI ABDOMEN W/O CONTRAST MRI ABDOMEN W CONTRAST MRI ABDOMEN W & W/O CONTRAST eviCore healthcare CPT Code List September 22, 2015 PLEASE NOTE: This list is subject to change. CPT codes are deleted and added each year by the American Medical Association (AMA). It is the responsibility of each practitioner to be aware of these coding changes. The health plan is not responsible to provide updates to this list as codes are periodically added and deleted by the AMA. 77058 77059 S8037 MRI BREAST UNILATERAL WITH AND/OR WITHOUT CONTRAST MRI BREAST BILATERAL WITH AND/OR WITHOUT CONTRAST MRCP S8042 MRI LOW FIELD NUCLEAR CARDIOLOGY SCANS: 78451 78452 78481 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) 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 (EXERCISE OR PHARMACOLOGIC) AND/OR REDISTRIBUTION AND/OR REST REINJECTION CARDIAC BLOOD POOL IMAGING (PLANAR), FIRST PASS TECHNIQUE; SINGLE STUDY, AT REST OR WITH STRESS (EXERCISE AND/OR PHARMACOLOGIC), WALL MOTION STUDY PLUS EJECTION FRACTION, WITH OR WITHOUT QUANTIFICATION. 78483 CARDIAC BLOOD POOL IMAGING, MULTI 78494 CARDIAC BLOOD POOL IMAGING, SPECT 78496 CARDIAC BLOOD POOL IMAGING, SINGLE AT REST PET SCANS: 78459 MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) METABOLIC EVAL. MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; SINGLE 78491 STUDY AT REST OR STRESS 78492 78608 78609 78811 78812 78813 MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; MULTIPLE STUDIES AT REST OR STRESS BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) METABOLIC EVALUATION BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) , PERFUSION EVALUATION TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); LIMITED AREA (EG, CHEST, HEAD/NECK) TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); SKULL BASE TO MID-THIGH TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); WHOLE BODY 78814 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION; LIMITED AREA (EG CHEST, HEAD/NECK) 78815 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION; SKULL BASE TO MID-THIGH eviCore healthcare CPT Code List September 22, 2015 PLEASE NOTE: This list is subject to change. CPT codes are deleted and added each year by the American Medical Association (AMA). It is the responsibility of each practitioner to be aware of these coding changes. The health plan is not responsible to provide updates to this list as codes are periodically added and deleted by the AMA. 78816 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION; WHOLE BODY G0219 G0235 PET IMAGING WHOLE BONE; MELANOMA FOR NON COVERED INDICATIONS PET IMAGING, ANY SITE NOT OTHERWISE SPECIFIED G0252 PET IMAGING, FULL AND PARTIAL-RING PET SCANNERS ONLY, FOR INITIAL DIAGNOSIS OF BREAST CANCER AND/OR SURGICAL PLANNING FOR BREAST CANCER (E.G. INITIAL STAGING OF AXILLARY LYMPH NODES) S8085 FLUORINE-18 FLUORODEOXYGLUCOSE (F-18 FDG) IMAGING USING DUAL-HEAD COINCIDENCE DETECTION SYSTEM (NON-DEDICATED PET SCAN) eviCore healthcare CPT Code List September 22, 2015
