CPT Code List

2015 CPT Radiology, ECHO, and PET Codes Requiring Review
(Please Note: Group # and Default CPT "1" are for internal claims processing use only)
Modality Body Part Group # CPT Description Default
CPT "1"
CT Head 1 70480 CT orbit, sella or posterior fossa; w/o contrast 1
CT Head 1 70481 CT orbit, sella or posterior fossa; with contrast 0
CT Head 1 70482 CT orbit, sella or posterior fossa; w/o contrast followed by contrast 0
CT Head 2 70486 CT maxillofacial area (sinus); w/o contrast 1
CT Head 2 70487 CT maxillofacial area (sinus); with contrast 0
CT Head 2 70488 CT maxillofacial area (sinus); w/o contrast followed by contrast 0
CT Head 3 70450 CT head or brain; w/o contrast 1
CT Head 3 70460 CT head or brain; with contrast 0
CT Head 3 70470 CT head or brain; w/o contrast followed by contrast 0
CT Neck 4 70490 CT soft tissue neck; w/o contrast 1
CT Neck 4 70491 CT soft tissue neck; with contrast 0
CT Neck 4 70492 CT soft tissue neck; w/o contrast followed by contrast 0
CT Chest 5 71250 CT thorax; w/o contrast (noncardiac) 1
CT Chest 5 71260 CT thorax; with contrast (noncardiac) 0
CT Chest 5 71270 CT thorax; w/o contrast followed by contrast (noncardiac) 0
CT Abdomen 6 74150 CT abdomen; w/o contrast 1
CT Abdomen 6 74160 CT abdomen; with contrast 0
CT Abdomen 6 74170 CT abdomen; w/o contrast followed by contrast 0
CT Pelvis 7 72192 CT pelvis; w/o contrast 1
CT Pelvis 7 72193 CT pelvis; with contrast 0
CT Pelvis 7 72194 CT pelvis; w/o contrast followed by contrast 0
CT Spine 8 72125 CT cervical spine; w/o contrast 1
CT Spine 8 72126 CT cervical spine; with contrast 0
CT Spine 8 72127 CT cervical spine; w/o contrast followed by contrast 0
CT Spine 9 72128 CT thoracic spine; w/o contrast 1
CT Spine 9 72129 CT thoracic spine; with contrast 0
CT Spine 9 72130 CT thoracic spine; w/o contrast followed by contrast 0
CT Spine 10 72131 CT lumbar spine; w/o contrast 1
CT Spine 10 72132 CT lumbar spine; with contrast 0
CT Spine 10 72133 CT lumbar spine; w/o contrast followed by contrast 0
CT Extremity 11 73200 CT upper extremity; w/o contrast 1
CT Extremity 11 73201 CT upper extremity; with contrast 0
CT Extremity 11 73202 CT upper extremity; w/o contrast followed by contrast 0
CT Extremity 12 73700 CT lower extremity; w/o contrast 1
CT Extremity 12 73701 CT lower extremity; with contrast 0
CT Extremity 12 73702 CT lower extremity; w/o contrast followed by contrast 0
MRI Head 13 70551 MRI brain; w/o contrast 1
MRI Head 13 70552 MRI brain; with contrast 0
MRI Head 13 70553 MRI brain; w/o contrast followed by contrast 0
MRI Extremity 14 73218 MRI upper extremity, other than joint w/o contrast 1
MRI Extremity 14 73219 MRI upper extremity, other than joint with contrast 0
MRI Extremity 14 73220 MRI upper extremity, other than joint w/o contrast followed by contrast 0
MRI Spine 15 72141 MRI cervical spine; w/o contrast 1
MRI Spine 15 72142 MRI cervical spine; with contrast 0
MRI Spine 15 72156 MRI cervical spine; w/o contrast followed by contrast 0
MRI Spine 16 72146 MRI thoracic spine; w/o contrast 1
MRI Spine 16 72147 MRI thoracic spine; with contrast 0
MRI Spine 16 72157 MRI thoracic spine; w/o contrast followed by contrast 0
MRI Spine 17 72148 MRI lumbar spine; w/o contrast 1
MRI Spine 17 72149 MRI lumbar spine; with contrast 0
MRI Spine 17 72158 MRI lumbar spine; w/o contrast followed by contrast 0
MRI Heart 18 75557 MRI Cardiac for morphology and function without contrast material; 1
MRI Heart 18 75559 MRI Cardiac for morphology and function without contrast material; with stress
imaging
019102 (10-2014)
0

MRI Heart 18 75561 MRI Cardiac for morphology and function without contrast material(s), followed
by contrast material(s) and further sequences;
0
MRI Heart 18 75563
MRI Cardiac for morphology and function without contrast material(s), followed by
contrast material(s) and further sequences; with stress imaging 0
NUC Card Heart 19 78451 Myocardial perfusion SPECT single study including qualitative or quantitative
wall motion, ejection fraction by 1st pass or gated technique, rest or stress
NUC Card Heart 19 78452 Myocardial perfusion SPECT multiple studies including qualitative or
quantitative wall motion, ejection fraction by 1st pass or gated technique, rest
0
1
NUC Card Heart 19 78453
Myocardial perfusion planar single study including qualitative or quantitative wall motion,
ejection fraction by 1st pass or gated technique, rest or stress 0
NUC Card Heart 19 78454 Myocardial perfusion planar multiple studies including qualitative or quantitative
wall motion, ejection fraction by 1st pass or gated technique, rest and/or stress
0
MRI Head 23 70540 MRI orbit, face and neck; w/o contrast 1
MRI Head 23 70542 MRI orbit, face and neck; with contrast 0
Modality Body Part Group # CPT Description Default
CPT "1"
MRI Head 23 70543 MRI orbit, face and neck; w/o contrast followed by contrast 0
MRI Head 24 70336 MRI temporomandibular joint(s) 1
MRI Chest 25 71550 MRI chest; w/o contrast 1
MRI Chest 25 71551 MRI chest; with contrast 0
MRI Chest 25 71552 MRI chest; w/o contrast followed by contrast 0
MRI Abdomen 26 74181 MRI abdomen; w/o contrast 1
MRI Abdomen 26 74182 MRI abdomen; with contrast 0
MRI Abdomen 26 74183 MRI abdomen; w/o contrast followed by contrast 0
MRI Pelvis 27 72195 MRI pelvis; w/o contrast 1
MRI Pelvis 27 72196 MRI pelvis; with contrast 0
MRI Pelvis 27 72197 MRI pelvis; w/o contrast followed by contrast 0
MRI Breast 29 77058 MRI pelvis; Unilateral 1
Effective
Date
10/27/14
MRI Breast 29 77059 MRI pelvis; Bi lateral 0
Effective
Date
10/27/14
MRI Other 30 77084 MRI bone marrow blood supply 1
MRA Head 31 70544 MRA head; w/o contrast 1
MRA Head 31 70545 MRA head; with contrast 0
MRA Head 31 70546 MRA head; w/o contrast followed by contrast 0
MRA Chest 32 71555 MRA chest; with or w/o contrast 1
MRA Abdomen 33 74185 MRA abdomen; with or w/o contrast 1
MRA Pelvis 34 72198 MRA pelvis; with or w/o contrast 1
MRA Extremity 35 73225 MRA upper extremity; with or w/o contrast 1
MRA Extremity 36 73725 MRA lower extremity; with or w/o contrast 1
MRA Spine 37 72159 MRA spinal canal and contents with or w/o contrast 1
CT Other 40 77078 CT bone mineral density study; axial skeleton 1
NUC Card Heart 44 78466 Planar, infarct avid; qualitative or quantitative 0
NUC Card Heart 44 78468 Planar, infarct avid; with ejection fraction by first pass technique 0
NUC Card Heart 44 78469 SPECT, infarct avid; with or w/o quantification 1
MRI Extremity 46 73718 MRI lower extremity, other than joint w/o contrast 0
MRI Extremity 46 73719 MRI lower extremity, other than joint w contrast 0
MRI Extremity 46 73720 MRI lower extremity, other than joint w/o contrast followed by contrast 0
MRI Extremity 46 73721 MRI lower extremity, any joint w/o contrast 1
MRI Extremity 46 73722 MRI lower extremity, any joint w contrast 0
MRI Extremity 46 73723 MRI lower extremity, any joint w/o contrast followed by contrast 0
MRI Extremity 47 73221 MRI upper extremity, any joint w/o contrast 1
MRI Extremity 47 73222 MRI upper extremity, any joint with contrast 0
MRI Extremity 47 73223 MRI upper extremity, any joint w/o contrast followed by contrast 0
019102 (10-2014)

CTA Head 72 70496 CTA head 1
CTA Neck 73 70498 CTA neck 1
MRA Neck 74 70547 MRA neck; w/o contrast 1
MRA Neck 74 70548 MRA neck; with contrast 0
MRA Neck 74 70549 MRA neck; w/o contrast followed by contrast 0
CTA Chest 75 71275 CTA chest (noncoronary) 1
CTA Pelvis 76 72191 CTA pelvis 1
CTA Extremity 77 73206 CTA upper extremity 1
CTA Extremity 78 73706 CTA lower extremity 1
CTA Abdomen 79 74175 CTA abdomen 1
CTA Abdomen 80 75635 CTA abdominal aorta & bilateral iliofemoral lower extremity runoff 1
CTA Abd/Pelvis 80 74174 CTA Abdomen & Pelvis 0
MRI Other 81 76390 MR Spectroscopy 1
Effective
Date
10/27/14
NUC Card Heart 82 78472 Cardiac blood pool, gated equilibrium; planar, single study, wall motion plus
1
ejection fraction
NUC Card Heart 82 78473 Cardiac blood pool gated equilibrium; planar, multiple studies, wall motion study
0
plus ejection fraction
NUC Card Heart 82 78481 Cardiac blood pool first pass tech; single study, wall motion study plus ejection
0
fraction
NUC Card Heart 82 78483 Cardiac blood pool first pass tech; multiple studies, wall motion study plus
0
ejection fraction
NUC Card Heart 82 78494 Cardiac blood pool gated equilibrium, SPECT, at rest, wall motion study plus
0
ejection fraction
ECHOCARDIOGRAPHY CODES - EFFECTIVE 2/9/2013 WA&OR, EFFECTIVE 1/1/2015 ALASKA
Group # CPT Description Default
Stress
Echo
Heart 93 93350
WA, OR Eff
2/9/2013
AK Eff
1/1/15
CPT "1"
Transthoracic Stress Echo, complete 1
(SE)
Stress
Echo
Resting
Trans
Heart 93 93351
WA, OR Eff
2/9/2013 AK
Eff 1/1/15
Transthoracic Stress Echo, complete w cont EKG 0
Group # CPT Description
Heart 94 93303
WA, OR Eff
2/9/2013 AK Transthoracic Echo cardiac anomalies
Eff 1/1/15
Modality Body Part Group # CPT Description Default
CPT "1"
Resting Heart 94 93304
Trans
WA, OR AK
Transthoracic Echo cardiac anomalies, limited
Eff 1/115
0
Resting
Trans
Resting
Trans
Heart 94 93306
WA, OR Eff
2/9/2013 AK
Eff 1/1/15
Transthoracic Echo complete w color & spectral 0
Heart 94 93307
WA, OR Eff
2/9/2013 AK
Eff 1/1/15
Transthoracic Echo complete wo color & spectral 1
Resting
Trans
Heart 94 93308
WA, OR Eff
2/9/2013 AK
Eff 1/1/15
Transthoracic Echo limited
0
Transesop
h
ageal Heart 95
Group # CPT Description
93312
WA, OR Eff
2/9/2013 AK Transesophageal Echo 1
Eff 1/1/15
019102 (10-2014)

Transesop
h
ageal Heart 95
Transesop
h
ageal Heart 95
Transesop
h
ageal Heart 95
Transesop
h
ageal Heart 95
Transesop
h
ageal Heart 95
93313
WA, OR Eff
2/9/2013
AK Eff
1/1/15
Transesophageal Echo probe only 0
93314
WA, OR Eff
2/9/2013 AK Transesophageal Echo interpretation 0
Eff 1/1/15
93315
WA, OR Eff
2/9/2013
AK Eff
1/1/15
Transesophageal Echo congenital 0
93316
WA, OR Eff
2/9/2013 Transesophageal Echo congenital, probe only 0
AK Eff
1/1/15
93317
WA, OR Eff
2/9/2013 AK Transesophageal Echo congenital interpretation 0
Eff 1/1/15
Group # CPT Description
Echo Add-
On Codes
(do not
Heart 93320 Doppler Echo complete
Echo Add-
On Codes
(do not
Heart 93321 Doppler Echo limited
Echo Add-
On Codes
(do not
Heart 93325 Doppler Echo flow velocity
Echo Add- Heart 93352 Echo contrast agent (SE only) group 93
O
Group # CPT Description Default
CPT "1"
PET Head 42 78608 PET brain, metabolic evaluation 1
PET Head 42 78609 PET brain, perfusion evaluation 0
Group # CPT Description
PET Heart 71 78459 PET myocardial, metabolic evaluation 1
PET Heart 71 78491 PET myocardial, perfusion, single study 0
PET Heart 71 78492 PET myocardial, perfusion, multiple studies 0
Group # CPT Description
PET Other 84 78811 PET tumor imaging, limited 0
Modality Body Part Group # CPT Description Default
CPT "1"
PET Other 84 78812 PET tumor imaging, skull to mid-thigh 0
PET Other 84 78813 PET tumor imaging, whole body 1
PET Other 84 78814 PET tumor imaging with concurrent CT, limited 0
PET Other 84 78815 PET tumor imaging with concurrent CT, skull to mid-thigh 0
PET Other 84 78816 PET tumor imaging with concurrent CT, whole body 0
CT Other 85 74263 Eff Computed Tomographic (CT) Colonagraphy, screening, including image postporcessing 1
Date
10/27/14
CT Other 86 74261
eff Date
10/27/2014
Computed Tomographic (CT) Colonagraphy,diagnostic, including image postprocessing;
without contrast material
1
CT Other 86 74262 Eff
Date
10/27/2014
MRI Head 88 70554
Eff Date
10/27/2014
MRI Head 88 70555
Eff Date
10/27/2014
Computed Tomographic (CT) Colonagraphy,diagnostic, including image postprocessing;
without contrast material(s) including non-contrast images, if performed
Functional MRI brain not requiring physician or psychologist 1
Functional MRI brain requiring physician or psychologist 0
0
019102 (10-2014)

CT Heart 98 75571
Eff Date
10/27/2014
CT Heart 99 75572
Eff Date
10/27/2014
CT Heart 99 75573
Eff Date
10/27/2014
Computed Tomographic, heart, without contrast material, with quantitive evaluation of
coronay calcium
Computed Tomographic, 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)
Computed Tomographic, heart, with contrast material, for evaluation of cardiac structure and
morphology in the setting of congenital hear disease (including 3D image postprocessing,
assessment of LV cardiac function, RV structure and function and evaluation of venous
structures, is performed)
CT Heart 100 75574 Computed tomograhic angiograhy, heart, coronary arteries and bypass graft(when present),
1
Eff Date with contrast material, including 3D image postprocessing including evaluation of cardiac
10/27/2014 structure and morphology, assessment of cardiac function, and evaluation of venous structures,
if performed)
CT Abd/Pelvis 101 74176 CT Abdomen & Pelvis without contrast 1
CT Abd/Pelvis 101 74177 CT Abdomen & Pelvis with contrast 0
CT Abd/Pelvis 101 74178 CT Abdomen & Pelvis wo/w contrast 0
1
1
0
MRI Other 102 S8032
Eff Date
1/1/2015
Low Dose CT Lung Cancer Screening 1
019102 (10-2014)
019102 (10-2014)