2014 CPT Radiology Codes Requiring Review
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1 CT Head CT orbit, sella or posterior fossa; w/o contrast 1 CT Head CT orbit, sella or posterior fossa; with CT orbit, sella or posterior fossa; w/o contrast CT Head followed by CT Head CT maxillofacial area (sinus); w/o contrast 1 CT Head CT maxillofacial area (sinus); with CT maxillofacial area (sinus); w/o contrast CT Head followed by CT Head CT head or brain; w/o contrast 1 CT Head CT head or brain; with CT head or brain; w/o contrast followed by CT Head CT Neck CT soft tissue neck; w/o contrast 1 CT Neck CT soft tissue neck; with CT soft tissue neck; w/o contrast followed by CT Neck CT Chest CT thorax; w/o contrast (noncardiac) 1 CT Chest CT thorax; with contrast (noncardiac) 0 CT thorax; w/o contrast followed by contrast CT Chest (noncardiac) 0 CT Abdomen CT abdomen; w/o contrast 1 CT Abdomen CT abdomen; with CT Abdomen CT abdomen; w/o contrast followed by CT Pelvis CT pelvis; w/o contrast 1 CT Pelvis CT pelvis; with CT Pelvis CT pelvis; w/o contrast followed by CT Spine CT cervical spine; w/o contrast 1 CT Spine CT cervical spine; with CT cervical spine; w/o contrast followed by CT Spine CT Spine CT thoracic spine; w/o contrast 1 CT Spine CT thoracic spine; with CT thoracic spine; w/o contrast followed by CT Spine CT Spine CT lumbar spine; w/o contrast 1 CT Spine CT lumbar spine; with CT lumbar spine; w/o contrast followed by CT Spine HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. AVAPEC
2 Anthem Healthkeepers Plus Page 2 of 6 CT Extremity CT upper extremity; w/o contrast 1 CT Extremity CT upper extremity; with CT upper extremity; w/o contrast followed by CT Extremity CT Extremity CT lower extremity; w/o contrast 1 CT Extremity CT lower extremity; with CT Extremity CT lower extremity; w/o contrast followed by MRI Head MRI brain; w/o contrast 1 MRI Head MRI brain; with MRI Head MRI brain; w/o contrast followed by MRI Extremity MRI upper extremity, other than joint w/o contrast 1 MRI Extremity MRI upper extremity, other than joint with MRI Extremity MRI upper extremity, other than joint w/o contrast followed by MRI Spine MRI cervical spine; w/o contrast 1 MRI Spine MRI cervical spine; with MRI Spine MRI cervical spine; w/o contrast followed by MRI Spine MRI thoracic spine; w/o contrast 1 MRI Spine MRI thoracic spine; with MRI Spine MRI thoracic spine; w/o contrast followed by MRI Spine MRI lumbar spine; w/o contrast 1 MRI Spine MRI lumbar spine; with MRI Spine MRI lumbar spine; w/o contrast followed by MRI Heart MRI for morphology and function without contrast material; 1 X MRI Heart MRI for morphology and function without contrast material; with stress imaging 0 X MRI Heart MRI for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; 0 X MRI Heart MRI for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging 0 X Card Heart Myocardial perfusion SPECT single study rest or stress 0 X
3 Modality Body Part Card Heart Card Heart Anthem Healthkeepers Plus Page 3 of 6 Myocardial perfusion SPECT multiple studies rest and/or stress 1 X Myocardial perfusion planar single study rest or stress 0 X Myocardial perfusion planar multiple studies Card Heart rest and/or stress 0 X MRI Head MRI orbit, face and neck; w/o contrast 1 MRI Head MRI orbit, face and neck; with MRI Head MRI orbit, face and neck; w/o contrast followed by MRI Head MRI temporomandibular joint(s) 1 MRI Chest MRI chest; w/o contrast 1 MRI Chest MRI chest; with MRI Chest MRI chest; w/o contrast followed by MRI Abdomen MRI abdomen; w/o contrast 1 MRI Abdomen MRI abdomen; with MRI Abdomen MRI abdomen; w/o contrast followed by MRI Pelvis MRI pelvis; w/o contrast 1 MRI Pelvis MRI pelvis; with MRI Pelvis MRI pelvis; w/o contrast followed by MRI Breast MRI breast; unilateral 1 MRI Breast MRI breast; bilateral 0 MRI Other MRI bone marrow blood supply 1 MRA Head MRA head; w/o contrast 1 MRA Head MRA head; with MRA Head MRA head; w/o contrast followed by MRA Chest MRA chest; with or w/o contrast 1 MRA Abdomen MRA abdomen; with or w/o contrast 1 MRA Pelvis MRA pelvis; with or w/o contrast 1 MRA Extremity MRA upper extremity; with or w/o contrast 1 MRA Extremity MRA lower extremity; with or w/o contrast 1 MRA spinal canal and contents with or w/o MRA Spine contrast 1 CT Other CT bone mineral density study; axial skeleton 1 PET Head PET brain, metabolic evaluation 1 PET Head PET brain, perfusion evaluation 0 Card Heart Planar, infarct avid; qualitative or quantitative 0 X
4 Anthem Healthkeepers Plus Page 4 of 6 Planar, infarct avid; with ejection fraction by first Card Heart pass technique 0 X Card Heart SPECT, infarct avid; with or w/o quantification 1 X MRI lower extremity, other than joint w/o MRI Extremity MRI Extremity MRI lower extremity, other than joint w MRI Extremity MRI lower extremity, other than joint w/o contrast followed by MRI Extremity MRI lower extremity, any joint w/o contrast 1 MRI Extremity MRI lower extremity, any joint w MRI Extremity MRI lower extremity, any joint w/o contrast followed by MRI Extremity MRI upper extremity, any joint w/o contrast 1 MRI Extremity MRI upper extremity, any joint with MRI Extremity MRI upper extremity, any joint w/o contrast followed by PET Heart PET myocardial, metabolic evaluation 1 X PET Heart PET myocardial, perfusion, single study 0 X PET Heart PET myocardial, perfusion, multiple studies 0 X CTA Head CTA head 1 CTA Neck CTA neck 1 MRA Neck MRA neck; w/o contrast 1 MRA Neck MRA neck; with MRA Neck MRA neck; w/o contrast followed by CTA Chest CTA chest (noncoronary) 1 CTA Pelvis CTA pelvis 1 CTA Extremity CTA upper extremity 1 CTA Extremity CTA lower extremity 1 CTA Abdomen CTA abdomen 1 CTA Abd/Pelvis CTA Abdomen & Pelvis 0 CTA Abdomen CTA abdominal aorta & bilateral iliofemoral lower extremity runoff 1 MRI Other MR Spectroscopy 1 Card Heart Card Heart Card Heart Card Heart Card Heart blood pool, gated equilibrium; planar, single study, wall motion plus ejection fraction 1 X blood pool gated equilibrium; planar, multiple studies, wall motion study plus ejection fraction 0 X blood pool first pass tech; single study, wall motion study plus ejection fraction 0 X blood pool first pass tech; multiple studies, wall motion study plus ejection fraction 0 X blood pool gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction 0 X
5 Anthem Healthkeepers Plus Page 5 of 6 PET Other PET tumor imaging, limited 0 PET Other PET tumor imaging, skull to mid-thigh 0 PET Other PET tumor imaging, whole body 1 PET Other PET tumor imaging with concurrent CT, limited 0 PET Other PET tumor imaging with concurrent CT, skull to mid-thigh 0 PET Other PET tumor imaging with concurrent CT, whole body 0 CT Other Computed tomographic (CT) colonography, screening, including image postprocessing 1 CT Other Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material 1 CT Other Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed 0 MRI Head Functional MRI brain not requiring physician or psychologist 1 MRI Head Functional MRI brain requiring physician or psychologist 0 CT Heart Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium 1 X CT Heart Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed) 1 X CT Heart Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, if performed) 0 X CTA Heart Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) 1 X CT Abd/Pelvis CT Abdomen & Pelvis without contrast 1 CT Abd/Pelvis CT Abdomen & Pelvis with CT Abd/Pelvis CT Abdomen & Pelvis wo/w
6 Secondary/Add-on CPT Codes Secondary codes do not require preauthorization or separate review Anthem Healthkeepers Plus Page 6 of 6 Applicable s CPT Description 1-12, 13-17, 23-27, 29, 30, 46, 47, or thru Limited follow-up CT D rendering w interpretation and reporting of CT, MRI, ultrasound or other tomography requiring or not requiring image postprocessing on an independent workstation blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (Add-on code to only) magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure) Add to: 75557, 75559, 75561, Echocardiography Echocardiogram CPT Description Stress Echo (SE) Transthoracic Stress Echo, complete Transthoracic Stress Echo, complete w cont EKG Resting Trans Echo (TTE) Transthoracic Echo cardiac anomalies 94 Transesophageal Echo (TEE) Transthoracic Echo cardiac anomalies, limited Transthoracic Echo complete w color & spectral Transthoracic Echo complete wo color & spectral Transthoracic Echo limited Transesophageal Echo Transesophageal Echo probe only Transesophageal Echo interpretation Transesophageal Echo congenital Transesophageal Echo congenital, probe only Transesophageal Echo congenital interpretation Echo Add-On Codes CPT Description Doppler Echo complete Doppler Echo limited Doppler Echo flow velocity Echo contrast agent (SE only) group 93
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