Summary & Overview
CPT 76497: Unlisted Computed Tomography Procedure
CPT code 76497 designates an unlisted computed tomography (CT) procedure and is used when a CT service performed does not have a specific CPT code. Nationally, unlisted procedure codes like 76497 are important because they require additional documentation and justification for payers to adjudicate claims and determine reimbursement. Use of 76497 can affect billing workflows, prior authorization processes, and payer review timelines.
Key payers in the scope of this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how 76497 is classified and billed, common administrative considerations for submission, and how major payers typically approach unlisted CT procedures. The publication summarizes benchmarks where available, highlights relevant policy and documentation expectations, and provides clinical context about when an unlisted CT code is applied versus using established CT CPT codes.
This guidance is written for a national audience and focuses on coding and administrative implications rather than clinical decision-making. Data not available in the input for specific modifiers, taxonomies, ICD-10 pairings, or payer-specific fee benchmarks will be noted where applicable in detailed sections.
Billing Code Overview
CPT code 76497 is an unlisted computed tomography procedure code used to report CT services that do not have a specific CPT code. It is intended for situations where the CT procedure performed falls outside of established, coded CT services.
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Service type: Computed tomography (CT) imaging
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Typical site of service: Radiology departments, hospital outpatient imaging centers, and freestanding imaging facilities
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents to the hospital emergency department with acute abdominal pain after blunt trauma from a motor vehicle collision. The trauma team requests an urgent computed tomography (CT) scan to evaluate for intra-abdominal injury that is not covered by a specific CPT code. The imaging order requests a CT protocol tailored to identify solid organ laceration, active hemorrhage, and pneumoperitoneum with multiplanar reformats and contrast phases as indicated.
The clinical workflow includes triage and registration, review of indication by radiology, IV access and contrast administration per protocol (unless contraindicated), performance of the CT acquisition including any nonstandard or institution-specific techniques, technologist processing of multiplanar reformats, and radiologist interpretation and dictation. Billing uses 76497 when the performed CT service does not match a specific CPT descriptor and represents a distinct CT procedure performed and documented in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation for the CT study |
TC |