Substitution Rules 2025 — CPT/HCPCS code-to-code mappings for CT and MR imaging
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This document lists code-to-code substitution mappings and related claim handling notes for various CT and MR imaging CPT codes used by eviCore; it affects billing/coding and precertification/claim submission processes for providers submitting radiology imaging claims.
No material clinical or coverage changes in this revision.
Coverage & Substitution Guidance
Precertification / claim allowance entries
Annotations in the substitution table indicate precertification and claim allowance guidance for specific CPT codes.
Annotated codes
- 70482 — annotations include 'PRECERTIFICATION GIVEN WITH THIS CPT CODE' and 'CLAIM SUBMITTED WITH THIS CPT CODE WILL BE ALLOWED' (maxillofacial CT mappings shown).
Code mapping listings
Code substitution and mapping listings from the document; many CPT codes have one-to-one or one-to-many equivalency mappings to alternate CPT or HCPCS codes (examples below).
Spine CT mappings
Upper/lower extremity and joint MR/CT mappings
- 73725 — MR angiography, lower extremity; listed with mappings and CTA cross-references in the lower extremity section.
Code substitution listings
Code description text and substitution mappings between CPT and some HCPCS codes for CT, MR and MRA procedures.
Abdomen/pelvis CT and MR mappings
MR/MRA upper extremity mappings
CPT / HCPCS Code Tables & Mapping Summary
| 72141 | Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material. |
| 72142 | Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s). |
| 72156 | Magnetic resonance (eg, proton) imaging, spinal canal and contents; without contrast material, followed by contrast material(s) and further sequences (cervical/lumbar mappings noted). |
| 73223 | Magnetic resonance imaging, upper extremity joint; without and with contrast material(s) (mappings shown). |
| 73700 | Computed tomography, lower extremity; without contrast (mappings shown). |
| 73718 | Magnetic resonance imaging, lower extremity other than joint; without contrast (mappings shown). |
| 74150 | Computed tomography, abdomen; without contrast material (mappings shown). |
| 74176 | Computed tomography, abdomen and pelvis; without contrast material (mappings shown). |
| 74185 | Magnetic resonance angiography, abdomen, with or without contrast material(s). |
Billing, Prior Authorization & Reviewer Guidance
Highlight precertification and claim-allowance annotations
Table entries explicitly show the annotations “PRECERTIFICATION GIVEN WITH THIS CPT CODE” and “CLAIM SUBMITTED WITH THIS CPT CODE WILL BE ALLOWED” for multiple maxillofacial/face CT CPT codes; providers should verify precertification status and note that claims submitted with the listed CPT may be allowed per the table before billing or appeal.
Use code mappings in the table for prior authorization validation
Prior authorization reviewers and providers must use the document’s code mappings when validating requested CPT/HCPCS for radiology procedures; the substitution listings show one-to-one and one-to-many mappings (e.g., 73223 → 73222; 73225 → C8934/C8935/C8936; 73700 → 73702) that should be checked during prior auth validation.
- Reference the mapping lines shown in the table to confirm whether an alternate CPT or HCPCS code is an acceptable substitute for the requested code.
- Use the listed mapping (code = ...) fields in the document as the authoritative source when reviewers validate requested codes.
Apply code substitution mappings when billing
When submitting claims, providers must apply the code substitution guidance from the substitution table — use the mapped CPT/HCPCS codes shown (code = ...) as the billed code where substitutions are indicated (for example 73225 mapped to C8934/C8935/C8936 or 73700 mapped to 73702).
Key Terms & Annotations
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.