| CT and CTA’s | Procedure Code |
| CT abdomen and pelvis w/o contrast; renal stone | 74176 |
| CT abdomen and pelvis; with contrast i.e. enterography | 74177 |
| CT abdomen and pelvis; w/o contrast followed by with contrast | 74178 |
| CT abdomen w/o followed by contrast | 74170 |
| CT abdomen; w/o contrast | 74150 |
| CT abdomen; with contrast | 74160 |
| CT ablation renal radiofrequency | 50592 |
| CT cervical spine; w/o contrast | 72125 |
| CT cervical spine; w/o contrast followed by with contrast | 72127 |
| CT cervical spine; with contrast | 72126 |
| CT chest (thorax) w/o contrast followed by contrast | 71270 |
| CT chest (thorax) w/o contrast – high resolution – limited | 71250 |
| CT chest (thorax) with contrast, chest tube placement | 71260 |
| CT CTA Abdomen/Pelvis Panel | 74174 |
| CT CTA Abdomen/Pelvis Panel; two separate orders/codes | 71275, 74174 |
| CT CTA Chest/Abdomen Panel; two separate orders/codes | 71275, 74175 |
| CT head or brain; w/o contrast, stroke protocol | 70450 |
| CT head or brain; w/o contrast followed by with contrast | 70470 |
| CT head or brain; with contrast | 70460 |
| CT heart score | 76380 |
| CT heart; w/o contrast, calcium scoring | 75571 |
| CT lower extremity; w/o contrast | 73700 |
| CT lower extremity; w/o contrast followed by contrast | 73702 |
| CT lower extremity; with contrast | 73701 |
| CPT Code Tool | |
| CT lumbar spine; w/o contrast | 72131 |
| CT lumbar spine; w/o contrast followed by with contrast | 72133 |
| CT lumbar spine; with contrast | 72132 |
| CT maxillofacial area limited w/o contrast, sinus | 70486 |
| CT maxillofacial area; w/o contrast followed by with contrast | 70488 |
| CT maxillofacial area; with contrast | 70487 |
| CT maxillofacial area; w/o contrast | 70486 |
| CT neck soft tissue w/o contrast | 70490 |
| CT neck soft tissue with contrast | 70491 |
| CT orbit; sella or posterior fossa; w/o contrast | 70480 |
| CT orbit; sella or posterior fossa; w/o contrast followed by with contrast | 70482 |
| CT orbit; sella or posterior fossa; with contrast | 70481 |
| CT pelvis; w/o contrast | 72192 |
| CT pelvis; w/o contrast followed by with contrast | 72194 |
| CT pelvis; with contrast | 72193 |
| CT soft tissue neck; w/o contrast | 70490 |
| CT soft tissue neck; w/o contrast followed by with contrast | 70492 |
| CT soft tissue neck; with contrast | 70491 |
| CT thoracic spine; w/o contrast | 72128 |
| CT thoracic spine; w/o contrast followed by with contrast | 72130 |
| CT thoracic spine; with contrast | 72129 |
| CT upper extremity; w/o contrast | 73200 |
| CT upper extremity; w/o contrast followed by contrast | 73202 |
| CT urogram | 74178 |
| CT upper extremity; with contrast | 73201 |
| CTA abdomen; w/o contrast followed by contrast and further sections | 74175 |
| CTA chest no coronary | 71275 |
| CPT Code Tool | |
| CTA head and neck (order separately) | 70496, 70498 |
| CTA head; w/o contrast followed by with contrast | 70496 |
| CTA heart coronary arteries and cardiac structure | 75574 |
| CTA lower extremity | 73706 |
| CTA neck; w/o contrast followed by with contrast | 70498 |
| CTA pelvis; w/o contrast followed by with contrast | 72191 |
| CTA runoff AAA bilateral lower extremity | 75635 |
| CTA upper extremity | 73206 |
Abdomen CT and Pelvis CT
Prior to 2011, computed tomography (CT) of the abdomen and CT of the pelvis could be reported, and were reimbursed, separately. CPT® 2011 created new codes (e.g., 74174 Computed tomography, abdomen and pelvis; without contrast material, 74177 Computed tomography, abdomen and pelvis; with contrast, and 74178 Computed tomography, abdomen and pelvis; without contrast material in 1 or both body regions, followed by contrast material(s) and further sections in 1 or both body regions) that bundle the procedures when performed together.
Such bundling has a significant financial impact. For example, per the 2012 Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Relative Value File, CT of the abdomen with contrast (74160 Computed tomography, abdomen; with contrast material(s)) is valued at 1.27 work relative value units (RVUs), while CT of the pelvis with contrast (72193 Computed tomography, pelvis; with contrast material(s)) is 1.16 RVUs.If reported separately, these codes total 2.43 RVUs. But when these procedures are bundled into the single code 74177 (as they have been since Jan. 1, 2011), the work RVUs are 1.82, or approximately 25 percent lower.
Advanced Radiology including PET scans, CT Scans, MRI’s require authorization inclusive of the following codes:
– PET Scans (78459, 78491, 78492, 78608, 78609, 78811 to 78816)
– Breast MRI’s (77058 through 77059)
– CT Cardiology studies (75571 through 75574)
– GI Endoscopy – 45378 effective February 1, 2016
– Injection procedure for shoulder arthrography/enhanced CT/MRI shoulder arthrography (23350) effective February 1, 2016
– All of the following radiology/imaging codes are effective February 1, 2016: 70460, 70470, 70481, 70482, 70486-70492, 70496, 70498, 70540, 70551-70553, 71250, 71260, 71270, 71275, 71550-71552, 72126, 72127, 72129, 72130, 72132, 72133, 72156-72158, 72192-72194, 72291, 72292, 73200-73202, 73218-73223, 73225, 73700-73702, 74150, 74160, 74170, 74174-74176, 74178, 74179, 75557, 75559, 75561, 75563, 75565, 76120, 76125, 77011-77013, 77021, 77022, 77084, 78226, 78227, 78350, 78351, 78445, 78451-78454,
GI Radiology services including 91110, 91111
Authorization for High-tech Imaging Services
Blue Cross and HMO Louisiana are contracted with AIM Specialty Health (AIM), an independent company, to administer authorization services for select elective outpatient high-tech imaging studies. All authorization requests should be made through iLinkBLUE using the ProviderPortalSM. Ordering physicians must contact AIM directly for authorization of the services mentioned in this section for Blue Cross, HMO Louisiana and Federal Employee Program (FEP) members. AIM conducts authorization services for the following outpatient, non-emergent imaging services for Blue Cross and HMO Louisiana:
• Computerized Tomography (CT) Scans
• Computerized Tomography Angiography (CTA)
• Magnetic Resonance Imaging (MRI) – excluding Procedure 70336 as these authorizations are handled directly by Blue Cross. Most Blue Cross member contracts do not cover this service; however, a few large employers do provide some level of coverage.
• Magnetic Resonance Angiography (MRA)
• Nuclear Cardiology Procedures
• Positron-Emission Tomography (PET) Scans
Please note: imaging studies performed in conjunction with emergency room services, inpatient hospitalization, outpatient surgery (hospitals and freestanding surgery centers) or 23-hour observations are not included in this radiology program.
Ordering physicians (whether a primary care physician (PCP) or specialist) are required to provide AIM with basic clinical information and patient demographics to obtain the authorization. The PCP will not be expected to obtain the authorization number if a specialist orders the test. Hospitals and freestanding facilities that perform the technical component of the imaging services cannot obtain an authorization number and should not obtain authorizations for ordering physicians; however, they may check the status of an authorization request through iLinkBLUE.
Blue Cross implements a full utilization review program in which all clinical information provided by the ordering physician will be reviewed against AIM’s clinical guidelines for medical necessity. If a request for authorization is denied, AIM notifies the ordering physician of the denial and the process for appeals. Reconsiderations and first-level appeals on authorizations denied for medical necessity should be sent directly to AIM. First-level appeals on authorizations denied as experimental/investigational should be sent directly to Blue Cross. Please allow ample time in scheduling diagnostic services to insure the authorization process is completed and approved before the patient receives services. Ordering physicians should contact AIM to obtain authorization in one of two ways:
1. Use iLinkBLUE Provider Suite to access AIM’s web-based application, ProviderPortalSM. Ordering physicians can easily enter authorization requests and get immediate response for most requests.
Additionally, both ordering and performing providers can check authorization status and view authorization numbers using the providerPortalSM.
2. Contact AIM directly by calling 1-866-455-8416.