Summary & Overview
CPT 71250: CT Scan of Thorax Without Contrast
CPT code 71250 is a widely utilized billing code for computed tomography (CT) scans of the thorax performed without contrast material. This diagnostic imaging procedure is essential for evaluating a range of chest conditions, including lung disorders, abnormal findings in the lung field, chronic obstructive pulmonary disease, shortness of breath, and chest pain. The code is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage across the healthcare landscape.
This publication provides a comprehensive overview of 71250, including payer coverage, clinical context, and related billing practices. Readers will gain insight into the procedure's role in diagnostic radiology, typical clinical indications, and how it fits within the broader spectrum of chest imaging services. The analysis also highlights associated modifiers, relevant physician taxonomies, and related CPT codes for thoracic imaging. Key benchmarks and policy updates are discussed to inform stakeholders about current trends and requirements in medical billing for chest CT scans. The information is designed to support healthcare professionals, administrators, and policy analysts in understanding the national significance and operational details of this procedure.
CPT Code Overview
CPT code 71250 represents a computed tomography (CT) scan of the thorax performed without the use of contrast material. This procedure is classified under Diagnostic Radiology (Diagnostic Imaging) Procedures of the Chest. It is commonly used to evaluate the lungs, mediastinum, and chest wall for a variety of clinical indications. The typical site of service for this procedure is not explicitly documented in the available sources. CT imaging of the thorax without contrast is a standard diagnostic tool in medical practice, providing detailed cross-sectional images to assist in the assessment of chest conditions.
Clinical & Coding Specifications
Clinical Context
A patient presents with symptoms such as shortness of breath, chest pain, or abnormal findings on a chest X-ray. The clinician orders a computed tomography (CT) scan of the thorax without contrast material to further evaluate the lungs and chest structures. The procedure is performed by a radiology team, and the images are interpreted by a diagnostic radiologist. This workflow is typical for patients with suspected lung disorders, chronic obstructive pulmonary disease, or nonspecific abnormal findings in the chest.
Coding Specifications
-
Modifier
26: Used to indicate the professional component, which covers the interpretation and reporting of the CT scan by the radiologist. -
Modifier
TC: Used to indicate the technical component, which covers the use of equipment, supplies, and technical staff for performing the CT scan.
| Modifier Code | Description |
|---|---|
26 | Professional Component |
TC | Technical Component |
- Associated Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
2085R0202X | Diagnostic Radiology Physician |
2085N0700X | Nuclear Radiology Physician |
2085P0229X | Pediatric Radiology Physician |
Related Diagnoses
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J98.4- Other disorders of lung- Relevant for patients with lung conditions not otherwise specified, warranting further imaging.
-
R91.8- Other nonspecific abnormal finding of lung field- Used when prior imaging or clinical assessment reveals abnormal findings needing clarification.
-
J44.9- Chronic obstructive pulmonary disease, unspecified- Commonly used for patients with COPD, where CT imaging helps assess disease extent or complications.
-
R06.02- Shortness of breath- Indicates a symptom prompting chest imaging to rule out pulmonary or cardiac causes.
-
R07.9- Chest pain, unspecified- Used when chest pain is present and imaging is needed to evaluate for possible thoracic pathology.
Related CPT Codes
| CPT Code | Description |
|---|---|
71260 | Computed tomography, thorax; with contrast material(s) |
71270 | Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections |
71275 | Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing |
-
71260is used when the CT scan of the thorax is performed with contrast material, often to enhance visualization of certain structures. -
71270is used when the CT scan is performed first without contrast, then followed by contrast material and additional imaging, which may be necessary for more comprehensive evaluation. -
71275is used for CT angiography of the chest (noncoronary), which includes both noncontrast and contrast images and postprocessing, typically for vascular assessment. -
These codes may be used as alternatives or in sequence depending on clinical indications and workflow.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 71250 is highest among UnitedHealth Group at $168.84, while Medicare's mean rate is significantly lower at $91.88. The average commercial benchmark (BUCA) stands at $148.20, which is over 60% higher than the Medicare mean rate, highlighting a substantial gap between public and commercial reimbursement levels.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare exhibits the widest spread ($76.00), indicating greater variability in rates, while Aetna has the tightest range ($54.17), suggesting more consistent reimbursement. Blue Cross Blue Shield, Cigna, and UnitedHealth Group all show moderate dispersion, with ranges between $85.00 and $107.67.
The table and chart below present a detailed breakdown of national mean rates and percentile benchmarks for each payer.
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