CPT CODES Please note… If the CPT code you need is not on this list or you are unsure of a CPT code please call us BEFORE submitting authorization 619-397-6577.

CT CPT CODES/ CONTRAST INDICATION CT Abdomen and Pelvis WITH: 74177, WITHOUT: 74176 CT Chest WITH: 71260, WITHOUT: 71250 CT Chest, Abdomen and Pelvis WITH: 71260, 74177 CT Head WITHOUT & WITH: 70470, WITHOUT: 70450 CT Maxillofacial Region (Sinuses) WITHOUT: 70486 CT Urogram (CT Abdomen / Pelvis without AND with contrast, WITHOUT & WITH: 74178 for a diagnosis related specifically to the urinary system only - i.e., Hematuria)

CT ANGIOGRAM CPT CODE____ CT Angiogram Head 70496 CT Angiogram Abdomen 74175 CT Angiogram Pelvis 72191 CT Angiogram Abdomen and Pelvis 74174 CT Angiogram Abdominal Aorta/Bilateral Iliofemoral lower extremity runoff 75635 CT Angiogram for Pulmonary Embolism 71275 CT Angiogram Chest 71275

ULTRASOUND CPT CODE____ Ultrasound Abdomen Complete 76700 Ultrasound Abdomen Limited (Gallbladder) 76705 Ultrasound Pelvis Complete and Transvaginal (female) 76856 & 76830 Ultrasound Aorta 76775 Ultrasound Bladder / Kidney 76770 Ultrasound Breast(s) 76641 Ultrasound Guided Breast Biopsy 76942 & 19102 Ultrasound Scrotal 76870 Ultrasound Thyroid / Neck 76536 Hysterosonogram 76831 & 58340 Venous Doppler (DVT) Bilateral 93970 Venous Doppler (DVT) Unilateral 93971 Carotid Duplex Bilateral 93880

OBSTETRIC ULTRASOUND CPT CODE__ Ultrasound OB Transabdominal, 14 Weeks or greater 76805 Ultrasound OB Transabdominal and Transvaginal, Under 14 Weeks 76801 & 76817 Ultrasound OB Transabdomina and Transvaginall, Under 14 Weeks, Twins 76801, 76802 & 76817 Ultrasound OB Transabdominal, 14 Weeks or Greater, Twins 76805 & 76810 Ultrasound OB Follow-Up, Re-Evaluation 76816

DEXA (Bone Density) CPT CODE__ DEXA Bone scan for Osteoporosis with Vertebral Fracture Assessment 77085

MAMMOGRAPHY CPT CODES__ Mammogram Digital Screening G0202 & 77052 Mammogram Digital Screening Complex (Screening patients w/ Implants) G0202 & 77052 Mammogram Digital Bilateral Diagnostic G0204 & 77051 Mammogram Digital Unilateral Diagnostic G0206 & 77051 Mammogram Digital Bilateral Recall G0204 Mammogram Digital Unilateral Recall G0206 Mammogram Digital Bilateral Follow up (six-month follow up exam) G0204 & 77051 Mammogram Digital Unilateral Follow up (six-month follow up exam) G0206 & 77051

CPT CODES CONT’D….

FLUOROSCOPY CPT CODES Barium Enema Solid 74270 Barium Enema w/air 74280 Upper GI Series w/air 74247 Small Bowel 74250 Upper GI/Small Bowel series 74249 Esophogram 74220 Hysterosalpingogram under Imaging Guidance 74740 & 58340 Cystogram under Imaging Guidance 74430 & 51600 Voiding Cystogram under Imaging Guidance 74455 & 51600

MRI CPT CODES / CONTRAST INDICATION_ MRI Abdomen WITHOUT: 74181, WITHOUT & WITH: 74183 MRI Brain, Pituitary or Sella, IAC WITHOUT: 70551, WITHOUT & WITH: 70553 MRI Orbits, Face WITHOUT: 70540, WITHOUT & WITH: 70543 MRI Cervical Spine WITHOUT: 72141, WITHOUT & WITH: 72156 MRI Thoracic Spine WITHOUT: 72146, WITHOUT & WITH: 72157 MRI Lumbosacral Spine WITHOUT: 72148, WITHOUT & WITH: 72158 MRI Lower Extremity Joint (Knee, Ankle, Hip) WITHOUT: 73721, WITHOUT & WITH: 73723 MRI Lower Extremity Non-Joint (Soft Tissues, Bones – Non-Joint) WITHOUT: 73718, WITHOUT & WITH: 73720 MRI Upper Extremity Joint (Shoulder, Elbow, Wrist) WITHOUT: 73221, WITHOUT & WITH: 73223 MRI Upper Extremity Non-Joint (Soft Tissues, Bones – Non-Joint) WITHOUT: 73218, WITHOUT & WITH: 73220 MRI Neck (Soft Tissue) WITHOUT: 70540, WITHOUT & WITH: 70543 MRI Pelvis WITHOUT: 72195, WITHOUT & WITH: 72197 MRI Breast - Bilateral WITHOUT or WITH: 77059 MRI Cholangiogram/MRCP /MRI ABD WITHOUT & WITH: 74183, 74181

MR ANGIOGRAM CPT CODES / CONTRAST INDICATION MRA Head WITHOUT: 70544 MRA Renal Arteries, with MRI Abdomen WITH: 74185 & 74183 MRA Abdomen/Abdominal Aorta (AAA), with MRI Abdomen WITH: 74185 & 74183 MRA Pelvis WITHOUT or WITH: 72198 MRA Lower Extremity WITHOUT or WITH: 73725 MRA Upper Extremity WITHOUT or WITH: 73225

MR ARTHROGRAM MRI CPT CODE/ FLUOROSCOPIC GUIDANCE CODE /INJECTION PROCEDURE CODE MR Arthrogram Shoulder 73222, 77002 & 23350 MR Arthrogram Hip 73722, 77002 & 27093 MR Arthrogram Knee 73722, 77002 & 27370 MR Arthrogram Wrist 73222, 77002 & 25246 MR Arthrogram Elbow 73222, 77002 & 24220 MR Arthrogram Ankle 73722, 77002 & 27648

THERAPEUTIC JOINT INJECTIONS FLUOROSCOPIC GUIDANCE CODE /INJECTION PROCEDURE CODE Therapeutic Injection under imaging guidance / Shoulder 77002 & 20610 Therapeutic Injection under imaging guidance / Hip 77002 & 20610 Therapeutic Injection under imaging guidance / Knee 77002 & 20610 Therapeutic Injection under imaging guidance / Wrist 77002 & 20605 Therapeutic Injection under imaging guidance / Elbow 77002 & 20605 Therapeutic Injection under imaging guidance / Ankle 77002 & 20605

Please note…If the CPT code you need is not on this list or you are unsure of a CPT code please call us BEFORE submitting authorization 619-397-6577.