Every imaging CPT code you bill most, by modality, with the contrast rules, modifiers and denial traps that go with them
A CT head is not one code. It’s three: 70450, 70460 and 70470. Pick the wrong one and you’re looking at a denial, an underpayment or a mismatch with the prior auth. Radiology coding is full of these small forks, and each one has money attached.
This cheat sheet covers the codes imaging centers, radiology groups and hospital outpatient departments bill most often in 2027. It’s organized by modality, so you can jump straight to the section you need. Each table gives the code, a plain-English description, the body area and whether contrast applies.
Radiology CPT codes are the five-digit AMA codes, 70010 through 79999, that describe imaging services: X-ray, CT, MRI, ultrasound, mammography, bone density, nuclear medicine, imaging guidance and radiation oncology. Each code tells the payer what body area was imaged, how it was imaged, and whether contrast was used.
That last part trips up more claims than anything else. One note before you start: CPT descriptors are copyrighted by the American Medical Association. The descriptions here are written in our own words for quick reference. Always confirm the official descriptor in your current-year CPT manual or encoder before you code.
The CPT Radiology section runs from 70010 to 79999 and splits into seven subsections by service type. Diagnostic radiology is the largest. It covers X-ray, CT, MRI and angiography, ordered by body area from head to toe.
| CPT Range | Subsection | What It Covers |
|---|---|---|
| 70010–76499 | Diagnostic radiology | X-ray, CT, MRI, MRA, CTA, fluoroscopy studies, vascular imaging |
| 76506–76999 | Diagnostic ultrasound | Head and neck, chest, abdomen, pelvis, OB, extremities, US guidance |
| 77001–77022 | Radiologic guidance | Fluoroscopic, CT and MR guidance for procedures |
| 77046–77067 | Breast, mammography | Screening and diagnostic mammography, breast MRI |
| 77071–77086 | Bone and joint studies | DEXA, bone age, skeletal surveys, vertebral fracture assessment |
| 77261–77799 | Radiation oncology | Treatment planning, simulation, delivery, brachytherapy |
| 78012–79999 | Nuclear medicine | SPECT, PET, PET/CT, bone scans, thyroid studies, radiopharmaceutical therapy |
Inside diagnostic radiology, the order follows anatomy: head and neck (70xxx), chest (71xxx), spine and pelvis (72xxx), upper and lower extremities (73xxx), abdomen and GI (74xxx), then vascular (75xxx). Once you know that pattern, you can usually guess the first two digits of a code before you look it up.
Three things sit outside the 70000 series but show up on almost every imaging claim. Contrast agents and radiopharmaceuticals are billed with HCPCS Level II codes (Q and A codes). Diagnoses are reported with ICD-10-CM codes to prove medical necessity. Many interventional procedures live in the Surgery section (10000–69999) and already include imaging guidance in the code.
Modifier 26 bills the professional component: the radiologist’s interpretation and signed report. Modifier TC bills the technical component: the equipment, technologist, supplies and facility. If one entity provides both, bill the code with no modifier. That’s global billing.
Most diagnostic imaging codes carry both components. Who bills what depends on the setting:
| Setting | Radiologist Bills | Facility Bills |
|---|---|---|
| Hospital outpatient or inpatient | CPT + 26 on the CMS-1500 | Technical portion on the UB-04 (no TC needed on the facility claim) |
| Freestanding imaging center that employs the radiologist | Global (no modifier) | Included in global |
| Imaging center using an outside reading group | CPT + 26 | CPT + TC |
| Physician office with its own X-ray, read by the practice | Global | Included in global |
Here’s where most billers slip up: a radiology group reading for a hospital submits the code without modifier 26. The payer either denies it as a duplicate of the facility’s technical claim or, worse, pays global and recoups it months later in an audit. If your group reads in more than one setting, set the modifier rule at the location level in your billing system, not per claim.
Some codes are professional-only (no TC exists), and some are technical-only. The Medicare Physician Fee Schedule shows the PC/TC indicator for every code. Check it before you build charge masters for a new site.
Most CT and MRI studies come in a family of three codes: without contrast, with contrast, and without followed by with contrast. Choose the code based on what was actually done during the session, as documented in the radiologist’s report.
| Study | Without Contrast | With Contrast | Without, Then With |
|---|---|---|---|
| CT head/brain | 70450 | 70460 | 70470 |
| CT chest | 71250 | 71260 | 71270 |
| CT abdomen and pelvis | 74176 | 74177 | 74178 |
| MRI brain | 70551 | 70552 | 70553 |
| MRI cervical spine | 72141 | 72142 | 72156 |
| MRI lumbar spine | 72148 | 72149 | 72158 |
Three rules settle most contrast questions:
MR arthrograms are the classic exception people miss. The MRI is coded “with contrast” (73222 upper extremity joint, 73722 lower extremity joint), and the joint injection is billed separately, for example 23350 for a shoulder arthrography injection, with fluoroscopic guidance 77002 where the payer allows it.
The contrast agent itself is billed separately with a HCPCS code in most outpatient settings. See the contrast HCPCS section below.
The tables below list the codes billed most often in each modality. Descriptions are shortened and paraphrased.
X-ray (plain film) CPT codes are coded by body part and by the number of views taken. A two-view chest X-ray is 71046, a single view is 71045. Count the views in the report, not the views ordered.
| CPT Code | Description | Body Area | Views |
|---|---|---|---|
| 71045 | Chest X-ray | Chest | 1 |
| 71046 | Chest X-ray | Chest | 2 |
| 71047 | Chest X-ray | Chest | 3 |
| 71048 | Chest X-ray | Chest | 4 or more |
| 72040 | Cervical spine X-ray | Spine | 2–3 |
| 72100 | Lumbosacral spine X-ray | Spine | 2–3 |
| 72110 | Lumbosacral spine X-ray | Spine | 4 or more |
| 73030 | Shoulder X-ray | Upper extremity | 2 or more |
| 73110 | Wrist X-ray, complete | Upper extremity | 3 or more |
| 73130 | Hand X-ray | Upper extremity | 3 or more |
| 73562 | Knee X-ray | Lower extremity | 3 |
| 73564 | Knee X-ray, complete | Lower extremity | 4 or more |
| 73610 | Ankle X-ray, complete | Lower extremity | 3 or more |
| 73630 | Foot X-ray, complete | Lower extremity | 3 or more |
| 74018 | Abdomen X-ray | Abdomen | 1 |
| 74019 | Abdomen X-ray | Abdomen | 2 |
Coding tip: Medicare cuts the technical payment for X-rays taken on film (modifier FX) and on computed radiography plates (modifier FY). If your site still runs CR equipment, the FY modifier is required on the TC or global claim. Leaving it off is a compliance problem, not just a coding miss.
CT scan CPT codes are chosen by body area and contrast status. 70450, CT head without contrast, is one of the highest-volume CT codes in any ED or outpatient setting. When the abdomen and pelvis are scanned in the same session, you must use a combined code, 74176, 74177 or 74178.
| CPT Code | Description | Body Area | Contrast |
|---|---|---|---|
| 70450 | CT head/brain | Head | Without |
| 70460 | CT head/brain | Head | With |
| 70470 | CT head/brain | Head | Without, then with |
| 70486 | CT maxillofacial/sinus | Head | Without |
| 70491 | CT soft tissue neck | Neck | With |
| 70496 | CT angiography, head | Head | CTA |
| 70498 | CT angiography, neck | Neck | CTA |
| 71250 | CT chest | Chest | Without |
| 71260 | CT chest | Chest | With |
| 71271 | Low-dose CT lung cancer screening | Chest | Without |
| 71275 | CT angiography, chest | Chest | CTA |
| 72125 | CT cervical spine | Spine | Without |
| 72131 | CT lumbar spine | Spine | Without |
| 74174 | CT angiography, abdomen and pelvis | Abdomen/pelvis | CTA |
| 74176 | CT abdomen and pelvis | Abdomen/pelvis | Without |
| 74177 | CT abdomen and pelvis | Abdomen/pelvis | With |
| 74178 | CT abdomen and pelvis | Abdomen/pelvis | Without in one or both regions, then with |
Coding tip: Billing 74150 (CT abdomen) plus 72192 (CT pelvis) for the same session is one of the most common CT denials we see. NCCI edits bundle them, and the payer either denies the claim or pays one region. Use the combined code every time both regions are scanned together.
CT and CTA studies almost always need prior authorization from commercial and Medicare Advantage plans, usually through a radiology benefit manager such as eviCore or Carelon. Get the auth number on the claim before it leaves the building.
MRI CPT codes depend on body area, contrast status and, for the extremities, whether the scan targets a joint or a non-joint area. MRI brain without contrast is 70551. MRI lumbar spine without contrast is 72148. MRI knee without contrast is 73721.
| CPT Code | Description | Body Area | Contrast |
|---|---|---|---|
| 70551 | MRI brain | Head | Without |
| 70552 | MRI brain | Head | With |
| 70553 | MRI brain | Head | Without, then with |
| 70544 | MR angiography, head | Head | Without |
| 70547 | MR angiography, neck | Neck | Without |
| 72141 | MRI cervical spine | Spine | Without |
| 72146 | MRI thoracic spine | Spine | Without |
| 72148 | MRI lumbar spine | Spine | Without |
| 72158 | MRI lumbar spine | Spine | Without, then with |
| 72195 | MRI pelvis | Pelvis | Without |
| 73218 | MRI upper extremity, non-joint | Upper extremity | Without |
| 73221 | MRI upper extremity joint (shoulder, elbow, wrist) | Upper extremity | Without |
| 73718 | MRI lower extremity, non-joint | Lower extremity | Without |
| 73721 | MRI lower extremity joint (hip, knee, ankle) | Lower extremity | Without |
| 74181 | MRI abdomen | Abdomen | Without |
| 74183 | MRI abdomen | Abdomen | Without, then with |
Coding tip: “Joint” versus “non-joint” is about what was imaged, not where the pain is. An MRI of the thigh for a muscle tear is 73718, even if the patient also has knee pain. If the order says “left leg MRI,” query the ordering provider. Guessing between 73718 and 73721 is how claims end up denied for a mismatch with the auth.
For bilateral extremity MRIs, most payers want each side on its own line with RT and LT, not modifier 50. The MRA family (70544–70549) is being restructured for 2027, so check your encoder’s 2027 update before you code head and neck MRA.
Diagnostic ultrasound CPT codes (76506–76999) split most body areas into a “complete” and a “limited” code. Complete abdominal ultrasound is 76700, limited is 76705. The report has to show every required element of the complete exam, or you code limited.
| CPT Code | Description | Body Area | Exam Type |
|---|---|---|---|
| 76536 | Soft tissue head and neck (thyroid) | Neck | — |
| 76641 | Breast, unilateral | Breast | Complete |
| 76642 | Breast, unilateral | Breast | Limited |
| 76700 | Abdomen | Abdomen | Complete |
| 76705 | Abdomen (e.g., RUQ, single organ) | Abdomen | Limited |
| 76770 | Retroperitoneal (renal, aorta) | Retroperitoneum | Complete |
| 76775 | Retroperitoneal | Retroperitoneum | Limited |
| 76801 | Obstetric, first trimester (under 14 weeks) | Pelvis | Complete |
| 76805 | Obstetric, 14 weeks or more | Pelvis | Complete |
| 76815 | Obstetric, limited | Pelvis | Limited |
| 76817 | Obstetric, transvaginal | Pelvis | — |
| 76830 | Transvaginal, non-obstetric | Pelvis | — |
| 76856 | Pelvic, non-obstetric | Pelvis | Complete |
| 76857 | Pelvic, non-obstetric | Pelvis | Limited |
| 76870 | Scrotum and contents | Pelvis | — |
| 76882 | Extremity, non-vascular | Extremity | Limited |
Coding tip: A complete abdominal ultrasound (76700) requires the liver, gallbladder, common bile duct, pancreas, spleen, kidneys, upper abdominal aorta and IVC. If the pancreas was obscured by bowel gas, the report must say so. Without that statement, an auditor will downcode it to 76705.
Vascular duplex studies are not in this range. Carotid duplex (93880) and lower extremity venous duplex (93970, 93971) sit in the 93000 Medicine section, though radiology groups bill them every day.
A screening mammogram is CPT 77067. Diagnostic mammograms are 77065 (one breast) and 77066 (both breasts). Computer-aided detection is included in all three codes, and 3D tomosynthesis is reported separately with an add-on code.
| CPT/HCPCS | Description | Type |
|---|---|---|
| 77067 | Screening mammography, bilateral, includes CAD | Screening |
| 77063 | Screening digital breast tomosynthesis, bilateral (add-on to 77067) | Screening |
| 77065 | Diagnostic mammography, unilateral, includes CAD | Diagnostic |
| 77066 | Diagnostic mammography, bilateral, includes CAD | Diagnostic |
| G0279 | Diagnostic digital breast tomosynthesis (Medicare, add-on to 77065/77066) | Diagnostic |
| 77046 | MRI breast, unilateral, without contrast | MRI |
| 77047 | MRI breast, bilateral, without contrast | MRI |
| 77048 | MRI breast, unilateral, without then with contrast, includes CAD | MRI |
| 77049 | MRI breast, bilateral, without then with contrast, includes CAD | MRI |
Coding tip: When a screening mammogram turns into a diagnostic workup on the same day, Medicare wants modifier GG on the diagnostic code. Without it, the second study looks like a duplicate and denies. Pair screening studies with Z12.31 and diagnostic studies with the actual finding or symptom code, never with Z12.31.
The standard DEXA bone density scan of the hip and spine is CPT 77080. If a vertebral fracture assessment is done in the same session, report 77085 instead of billing 77080 and 77086 together.
| CPT Code | Description | Skeleton |
|---|---|---|
| 77080 | DXA bone density, axial (hip, pelvis, spine) | Axial |
| 77081 | DXA bone density, appendicular (forearm, heel) | Appendicular |
| 77085 | DXA axial plus vertebral fracture assessment | Axial |
| 77086 | Vertebral fracture assessment alone | Spine |
| 77078 | CT bone density, axial | Axial |
Medicare generally covers a DEXA once every 24 months. Shorter intervals need a qualifying reason, such as long-term glucocorticoid therapy or monitoring response to an FDA-approved osteoporosis drug. Check the frequency before the scan, not after the denial.
Nuclear medicine CPT codes (78012–79999) cover the imaging procedure only. The radiopharmaceutical is billed separately with a HCPCS A-code. The most common oncology PET/CT code is 78815, skull base to mid-thigh.
| CPT Code | Description | System |
|---|---|---|
| 78014 | Thyroid uptake with imaging | Endocrine |
| 78226 | Hepatobiliary (HIDA) scan | GI |
| 78227 | HIDA scan with pharmacologic intervention (e.g., CCK) | GI |
| 78306 | Bone scan, whole body | Musculoskeletal |
| 78452 | Myocardial perfusion SPECT, multiple studies (rest and stress) | Cardiac |
| 78582 | Lung ventilation and perfusion (V/Q) | Respiratory |
| 78608 | Brain PET, metabolic | Nervous |
| 78815 | PET/CT, skull base to mid-thigh | Oncology |
| 78816 | PET/CT, whole body | Oncology |
Coding tip: Medicare oncology PET claims need modifier PI (initial treatment strategy) or PS (subsequent treatment strategy). Miss it and the claim rejects at the front end. On a cardiac stress test, 78452 covers the imaging only. The stress portion goes on separately with 93015–93018.
Imaging guidance codes (77001–77022 and 76942) report fluoroscopic, CT, MR or ultrasound guidance for a procedure. Before you add one, check the procedure code. Many procedures now include imaging guidance, and billing it separately is unbundling.
| CPT Code | Description | Guidance Type |
|---|---|---|
| 76942 | Ultrasound guidance for needle placement | Ultrasound |
| 77001 | Fluoroscopic guidance for central venous access (add-on) | Fluoroscopy |
| 77002 | Fluoroscopic guidance for needle placement | Fluoroscopy |
| 77003 | Fluoroscopic guidance for spine or paraspinal injection | Fluoroscopy |
| 77012 | CT guidance for needle placement | CT |
| 77021 | MR guidance for needle placement | MRI |
Codes that already include imaging guidance include FNA biopsies (10005–10012), joint injections with ultrasound (20604, 20606, 20611), thoracentesis and pleural drainage with imaging (32555, 32557), paracentesis with imaging (49083), epidural injections (62320–62327 with imaging, 64479–64484) and facet injections (64490–64495). If your coder adds 77003 or 76942 to any of these, NCCI will catch it, and so will an auditor.
Interventional radiology procedures are mostly coded from the Surgery and Medicine sections, not the 70000 series. Paracentesis with imaging guidance is 49083. Thoracentesis with imaging is 32555. Both include the imaging, so no separate guidance code is billed.
| CPT Code | Description | Imaging Included? |
|---|---|---|
| 10005 | Fine needle aspiration biopsy, ultrasound guided, first lesion | Yes |
| 10009 | Fine needle aspiration biopsy, CT guided, first lesion | Yes |
| 32555 | Thoracentesis with imaging guidance | Yes |
| 49083 | Paracentesis with imaging guidance | Yes |
| 49405 | Image-guided percutaneous drainage, visceral collection | Yes |
| 36573 | PICC insertion with imaging guidance, age 5 or older | Yes |
| 62328 | Diagnostic lumbar puncture with fluoroscopic or CT guidance | Yes |
IR coding is where documentation detail pays off most. Selective catheter placement, vessel order, and each embolized territory change the code set. A one-line report (“successful embolization”) leaves money on the table every time.
The most used radiology modifiers are 26 (professional component), TC (technical component), RT and LT (laterality), 59 or XU (distinct service), and 76 or 77 (repeat procedure). Missing RT and LT is one of the easiest imaging denials to prevent.
| Modifier | Meaning | When to Use It in Radiology |
|---|---|---|
| 26 | Professional component | Radiologist reading in a hospital or for an outside facility |
| TC | Technical component | Facility or imaging center billing equipment and tech only |
| RT / LT | Right / left side | Every extremity study and unilateral breast study |
| 50 | Bilateral procedure | Only when the payer's bilateral indicator allows it; many want RT and LT lines instead |
| 59 / XU | Distinct procedural service / unusual non-overlapping service | Two services that normally bundle but were separate (different session, site or encounter). Use XU, XS or XE when the payer accepts X modifiers |
| 76 | Repeat procedure, same physician | Second chest X-ray the same day after a line placement |
| 77 | Repeat procedure, different physician | Same study repeated and read by another radiologist |
| 52 | Reduced service | Study started but fewer views or elements completed |
| 53 | Discontinued procedure | Patient could not tolerate the exam and it was stopped |
| GG | Screening and diagnostic mammogram, same day (Medicare) | Diagnostic study converted from a screening the same day |
| FX / FY | X-ray taken on film / computed radiography | Required on the technical claim; triggers a payment reduction |
| PI / PS | Initial / subsequent anti-tumor strategy (Medicare PET) | Oncology FDG PET studies |
Modifier 59 is the one auditors watch. Use it only when the documentation shows a separate session, site or encounter. Adding 59 just to get past an edit is the fastest way to turn a coding issue into a repayment demand.
Contrast agents and radiopharmaceuticals are billed with HCPCS Level II codes, separate from the CPT imaging code. Iodinated CT contrast uses Q9965–Q9967, priced per mL. Gadolinium MRI agents use A-codes, and several are priced per 0.1 mL, so units are where most errors happen.
| HCPCS | Agent | Billing Unit |
|---|---|---|
| Q9965 | Low osmolar contrast, 100–199 mg iodine/mL | Per 1 mL |
| Q9966 | Low osmolar contrast, 200–299 mg iodine/mL | Per 1 mL |
| Q9967 | Low osmolar contrast, 300–399 mg iodine/mL | Per 1 mL |
| A9575 | Gadoterate meglumine (Dotarem, Clariscan) | Per 0.1 mL |
| A9576 | Gadoteridol (ProHance) | Per 1 mL |
| A9577 | Gadobenate dimeglumine (MultiHance) | Per 1 mL |
| A9585 | Gadobutrol (Gadavist) | Per 0.1 mL |
| A9579 | Gadolinium-based agent, not otherwise specified | Per 1 mL |
| A9552 | F-18 FDG, diagnostic (PET) | Per study dose, up to 45 mCi |
| A9500 | Tc-99m sestamibi (cardiac perfusion) | Per study dose |
| A9503 | Tc-99m medronate (bone scan) | Per study dose, up to 30 mCi |
Do the unit math every time. 100 mL of Omnipaque 350 is Q9967 × 100 units. 15 mL of Gadavist is A9585 × 150 units, not 15. Billing 15 units underpays you by 90%. Billing 150 units of a per-mL agent overbills tenfold, and that one gets noticed.
In the hospital outpatient setting, Medicare packages contrast into the imaging payment under OPPS. Still report the HCPCS code. It’s part of the cost data CMS uses to set future rates.
Most radiology denials come from seven issues: missing prior authorization, diagnosis codes that don’t support medical necessity, a CPT code that doesn’t match the auth, bundling edits, missing laterality, wrong contrast units and frequency limits. Nearly all of them can be caught before the claim is submitted.
| Denial Reason | What Usually Happened | Fix |
|---|---|---|
| No prior authorization | CT, MRI or PET done without an auth, or the auth expired | Verify auth at scheduling and again on the day of service |
| CPT doesn't match auth | Auth for 70551, radiologist added contrast and it became 70553 | Update the auth within the payer's window, usually 1–2 business days |
| Medical necessity | ICD-10 code is vague (R52 "pain, unspecified") or not on the payer's LCD list | Code to the highest specificity in the order and report; query when vague |
| Bundling (NCCI) | 74150 + 72192 same session, or guidance billed with a code that includes it | Run every claim through an NCCI-current scrubber |
| Missing laterality | Extremity study without RT or LT | Make RT/LT a required field for 73xxx codes |
| Contrast units | Per-0.1 mL agent billed per mL | Build unit conversions into the charge master |
| Frequency limits | Screening mammogram or DEXA billed too soon | Check last date of service before scheduling |
The pattern behind all of these: radiology denials are rarely about the read. They’re about the paperwork around it. Practices that check auth, ICD-10 specificity and NCCI edits before submission typically see first-pass acceptance rates well above those that rely on working denials after the fact.
The CPT 2027 code set takes effect January 1, 2027, with 453 changes overall: 299 new codes, 74 revised and 80 deleted. For imaging, the biggest change is a new structure for head and neck MR angiography, with post-processing now built into the code descriptors.
What radiology and IR teams need to update:
CMS payment policy and payer edits for the new codes come later. Expect the first wave of 2027 denials in February and March, when payer systems catch up with the code set. Load the new codes into your charge master and scrubber in December, not January.
Sources: AMA, CPT 2027 code set release · StreamlineMD, CPT 2027 changes for radiology and IR
A cheat sheet helps you find the code. It won’t catch the expired auth, the missing RT modifier or the contrast billed in the wrong units. Our certified radiology coders review every claim against current NCCI edits, payer policies and the 2027 code set before it goes out.
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