CPT Description Group 74150 CT abdomen; without contrast
74160 CT abdomen; with contrast
74170 CT abdomen; without contrast followed by contrast 74181 MRI abdomen; without contrast
74182 MRI abdomen; with contrast
74183 MRI abdomen; without contrast followed by contrast
74175 CTA abdomen Angiography, Abdomen - CT
74185 MRA abdomen; with or without contrast Angiography, Abdomen - MRA
71555 MRA chest; with or without contrast Angiography, Chest - MRA
70496 CTA head Angiography, Head - CT
70544 MRA head; without contrast 70545 MRA head; with contrast
70546 MRA head; without contrast followed by contrast
73706 CTA lower extremity Angiography, Lower Extremity - CT
73725 MRA lower extremity; with or without contrast Angiography, Lower Extremity - MRA
70498 CTA neck Angiography, Neck - CT
70547 MRA neck; without contrast 70548 MRA neck; with contrast
70549 MRA neck; without contrast followed by contrast
72191 CTA pelvis Angiography, Pelvis - CT
72198 MRA pelvis; with or without contrast Angiography, Pelvis - MRA
72159 MRA spinal canal and contents with or without contrast Angiography, Spinal Canal & Contents - MRA
73206 CTA upper extremity Angiography, Upper Extremity - CT
73225 MRA upper extremity; with or without contrast Angiography, Upper Extremity - MRA 77078 CT bone mineral density study; axial skeleton Bone Density (CT)
77084 MRI bone marrow blood supply Bone Marrow Blood Supply - MRI
70551 MRI brain; without contrast 70552 MRI brain; with contrast
70553 MRI brain; without contrast followed by contrast 78608 PET brain, metabolic evaluation
78609 PET brain, perfusion evaluation 77058 MRI breast; unilateral
77059 MRI breast; bilateral
75557 MRI Cardiac for morphology and function without contrast material;
75559 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
78472 Cardiac blood pool, gated equilibrium; planar, single study, wall motion plus ejection fraction
78473 Cardiac blood pool gated equilibrium; planar, multiple studies, wall motion study plus ejection fraction
78481 Cardiac blood pool first pass tech; single study, wall motion study plus ejection fraction
78483 Cardiac blood pool first pass tech; multiple studies, wall motion study plus ejection fraction
78494 Cardiac blood pool gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction
*Secondary codes or add-on codes do not require preauthorization or separate review.
CPT Radiology Codes Requiring Review by AIM Effective 01/01/2016
When a service is authorized only one test per group is payable.
Abdomen - CT
Abdomen - MRI
Angiography, Head - MRA
Angiography, Neck - MRA
Brain (Includes IACs, Pituitary) - MRI
Brain Imaging (PET Scan)
Breast (MR Mammography) - MRI
Cardiac - MRI
CPT Description Group 75571 Computed tomography, heart, without contrast material, with
quantitative evaluation of coronary calcium Cardiac CT - Calcium Scoring
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)
78459 PET myocardial, metabolic evaluation 78491 PET myocardial, perfusion, single study 78492 PET myocardial, perfusion, multiple studies 72125 CT cervical spine; without contrast
72126 CT cervical spine; with contrast
72127 CT cervical spine; without contrast followed by contrast 72141 MRI cervical spine; without contrast
72142 MRI cervical spine; with contrast
72156 MRI cervical spine; without contrast followed by contrast 71550 MRI chest; without contrast
71551 MRI chest; with contrast
71552 MRI chest; without contrast followed by contrast 71250 CT thorax; without contrast (non-cardiac) 71260 CT thorax; with contrast (non-cardiac)
71270 CT thorax; without contrast followed by contrast (non-cardiac)
75574
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)
Coronary (Cardiac) CTA
74176 CT Abdomen & Pelvis without contrast 74177 CT Abdomen & Pelvis with contrast 74178 CT Abdomen & Pelvis wo/w contrast 74174 CTA Abdomen/Pelvis wo/w contrast
75635 CTA Abdomen aorta w bilateral iliofemoral low extremity
runoff CTA Abdomen Aorta w Low Extremity Runoff
71275 CTA chest (non-coronary) CTA Chest (Non-coronary)
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
70554 Functional MRI brain not requiring physician or psychologist 70555 Functional MRI brain requiring physician or psychologist 70480 CT orbit, sella or posterior fossa; without contrast 70481 CT orbit, sella or posterior fossa; with contrast
70482 CT orbit, sella or posterior fossa; without contrast followed by contrast
70450 CT head or brain; without contrast 70460 CT head or brain; with contrast
70470 CT head or brain; without contrast followed by contrast 78466 Planar, infarct avid; qualitative or quantitative
78468 Planar, infarct avid; with ejection fraction by first pass technique
78469 SPECT, infarct avid; with or without quantification
Cardiac CT - Structure/Morphology
Cardiac Imaging (PET Scan)
Cervical Spine - CT
Cervical Spine - MRI
Chest - MRI
Chest (Thorax) - CT
CT Abdomen/Pelvis Combination
Diagnostic Virtual Colonoscopy
Functional MRI Brain
Head - CT
Head/Brain - CT
73700 CT lower extremity; without contrast 73701 CT lower extremity; with contrast
73702 CT lower extremity; without contrast followed by contrast 73718 MRI lower extremity, other than joint without contrast 73719 MRI lower extremity, other than joint w contrast 73720 MRI lower extremity, other than joint without contrast
followed by contrast
73721 MRI lower extremity, any joint without contrast 73722 MRI lower extremity, any joint w contrast
73723 MRI lower extremity, any joint without contrast followed by contrast
72131 CT lumbar spine; without contrast 72132 CT lumbar spine; with contrast
72133 CT lumbar spine; without contrast followed by contrast 72148 MRI lumbar spine; without contrast
72149 MRI lumbar spine; with contrast
72158 MRI lumbar spine; without contrast followed by contrast
S8032 Low Dose CT Lung Cancer Screening Lung Cancer Screening - Low Dose CT
G0297 Low dose CT lung screening Lung Cancer Screening Low Dose CT Medicare
70486 CT maxillofacial area (sinus); without contrast 70487 CT maxillofacial area (sinus); with contrast
70488 CT maxillofacial area (sinus); without contrast followed by contrast
74712 MRI Fetal MRI Fetal
78451
Myocardial perfusion SPECT single study including
qualitative or quantitative wall motion, ejection fraction by 1st pass or gated technique, rest or stress
78452
Myocardial perfusion SPECT multiple studies including qualitative or quantitative wall motion, ejection fraction by 1st pass or gated technique, rest and/or stress
78453
Myocardial perfusion planar single study including qualitative or quantitative wall motion, ejection fraction by 1st pass or gated technique, rest or stress
78454
Myocardial perfusion planar multiple studies including qualitative or quantitative wall motion, ejection fraction by 1st pass or gated technique, rest and/or stress
70490 CT soft tissue neck; without contrast 70491 CT soft tissue neck; with contrast
70492 CT soft tissue neck; without contrast followed by contrast 70540 MRI orbit, face and neck; without contrast
70542 MRI orbit, face and neck; with contrast
70543 MRI orbit, face and neck; without contrast followed by contrast
72192 CT pelvis; without contrast 72193 CT pelvis; with contrast
72194 CT pelvis; without contrast followed by contrast 72195 MRI pelvis; without contrast
72196 MRI pelvis; with contrast
72197 MRI pelvis; without contrast followed by contrast 78811 PET tumor imaging, limited
78812 PET tumor imaging, skull to mid-thigh 78813 PET tumor imaging, whole body
78814 PET tumor imaging with concurrent CT, limited
78815 PET tumor imaging with concurrent CT, skull to mid-thigh 78816 PET tumor imaging with concurrent CT, whole body 74263 Computed tomographic (CT) colonography, screening,
including image post processing Screening Virtual Colonoscopy
76390 MR Spectroscopy Spectroscopy - MRI
70336 MRI temporomandibular joint(s) Temporomandibular Joints (TMJ) - MRI
Lower Extremity - CT
Lower Extremity Joint/Non-joint - MRI
Lumbar Spine - CT
Lumbar Spine - MRI
Maxillofacial Area (Sinus) - CT
Myocardial Perfusion Imaging
Neck (Soft Tissue) - CT
Orbit, Face, Soft Tissue Neck - MRI
Pelvis - CT
Pelvis - MRI
CPT Description Group 72128 CT thoracic spine; without contrast
72129 CT thoracic spine; with contrast
72130 CT thoracic spine; without contrast followed by contrast 72146 MRI thoracic spine; without contrast
72147 MRI thoracic spine; with contrast
72157 MRI thoracic spine; without contrast followed by contrast 73200 CT upper extremity; without contrast
73201 CT upper extremity; with contrast
73202 CT upper extremity; without contrast followed by contrast 73221 MRI upper extremity, any joint without contrast
73222 MRI upper extremity, any joint with contrast
73223 MRI upper extremity, any joint without contrast followed by contrast
73218 MRI upper extremity, other than joint without contrast 73219 MRI upper extremity, other than joint with contrast 73220 MRI upper extremity, other than joint without contrast
followed by contrast
CPT* Description Group
76376 or 76377
3D rendering w interpretation and reporting of CT, MRI, ultrasound or other tomography requiring or not requiring image post processing on an independent workstation 76380 Limited follow-up CT
78496
Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (Add-on code to 78472 only)
75565 Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure)
74712
Magnetic resonance (e.g., proton) imaging, fetal, including placental an maternal pelvic imaging when performed; each additional gestation (list separately in addition to code from primary procedure 74712)
Add-on Codes* Thoracic Spine - CT
Thoracic Spine - MRI
Upper Extremity - CT
Upper Extremity Joint - MRI
Upper Extremity Non-Joint (includes Brachialplexus) - MRI
Applicable Groups CPT Description 1-12, 13-17, 23-27, 29, 30, 46, 47, 101 76376 or 76377
3D rendering w interpretation and reporting of CT, MRI, ultrasound or other tomography requiring or not requiring image postprocessing on an independent workstation
74712
Magnetic resonance (eg, proton) imaging, fetal, including placental an maternal pelvid imaging when performed; each additional gestation (list separately in addition to code from primary procedure 74712)
Secondary/Add-on CPT Codes
