Summary & Overview
CPT 70486: CT Maxillofacial Exam, Non-Contrast
CPT code 70486 identifies a non-contrast computed tomography (CT) examination of the maxillofacial region. This imaging service is commonly used to evaluate facial bones, the upper jaw (maxilla), orbits, and adjacent soft tissues when contrast is not required or contraindicated. Nationally, CT imaging of the maxillofacial area is an important diagnostic tool for trauma evaluation, preoperative planning, and assessment of facial infections or anatomic pathology.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and reimbursement rules for non-contrast maxillofacial CT vary by payer and can influence site-of-service decisions, prior authorization requirements, and coding guidance for bundled or separate technical and professional components.
Readers will find a concise overview of clinical context for CPT code 70486, typical sites of service, common billing modifiers (listed separately), and the kinds of benchmarks and policy updates that affect utilization and payment. The publication also summarizes where to expect prior authorization triggers, clinical indications that commonly support the service, and operational considerations relevant to imaging centers and hospital radiology departments. Data not available in the input is noted explicitly where applicable.
Billing Code Overview
CPT code 70486 describes a computed tomography (CT) exam of the maxillofacial area without contrast. The procedure uses CT imaging to evaluate facial structures such as the upper jaw, orbits, sinuses adjacent to the maxilla, and other maxillofacial anatomy. The description specifies that no intravenous or oral contrast is administered for this exam.
Service Type: Diagnostic radiology — CT imaging (non-contrast), maxillofacial region
Typical Site of Service: Outpatient imaging center or hospital radiology department, and may also be performed in urgent care or emergency department imaging suites depending on clinical need.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 34-year-old adult presenting to the emergency department or outpatient imaging center after facial trauma (e.g., assault, motor vehicle collision, or fall) with facial pain, swelling, epistaxis, or malocclusion. The clinician orders a non-contrast maxillofacial CT to evaluate suspected fractures of the maxilla, zygoma, orbital floor, nasal bones, or mandible, to assess for foreign bodies, evaluate complex sinus disease, or plan surgical repair. The imaging workflow includes triage by the ordering provider, scheduling/transport to CT, patient screening for contrast allergies (not applicable for this non-contrast exam), positioning in the CT scanner, acquisition of axial thin-slice images with multiplanar reconstructions, technologist processing, and radiologist interpretation. The radiology report documents fracture location and extent, sinus involvement, orbital floor integrity, and any acute hemorrhage or retained foreign bodies. Results are communicated to the referring provider for definitive management, which may include surgical consultation, dental or maxillofacial follow-up, or conservative care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the interpreting physician's professional service is billed separate from technical component. |
TC |