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CMS Transmittals




70390
Quick jump to procedure code: Printer Friendly Version
70460

Procedure Category: Radiology
Procedure Subcategory: Diagnostic Radiology

70450: CT HEAD/BRAIN W/O DYE

CPT® 70450: Computed tomography, head or brain; without contrast material



--

CPT copyright 2017 American Medical Association. All rights reserved.


2018 Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

Global Fee $118.08
* 26 Modifier $ 43.56
* TC Modifier $ 74.52
2018 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2018D Unadjusted OPPS Payment $114.46
2018 APC Code: 5522
Level 2 Imaging without Contrast

Composite APC: 8005
CT and CTA without Contrast Composite

2018 OPPS Status Indicator: Q3

* This procedure is subject to the Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures - CMS Transmittal 1104

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
13.6%
S09.90XA
Unspecified injury of head, initial encounter
011-013
913-914
955-965
12.3%
R51
Headache
102-103
11.2%
R41.82
Altered mental status, unspecified
947-948
5.8%
R42
Dizziness and giddiness
149
3.8%
R55
Syncope and collapse
312
3.2%
I63.9
Cerebral infarction, unspecified
023-027
061-063
064-066
793
2.9%
R41.0
Disorientation, unspecified
947-948
2.7%
R53.1
Weakness
947-948
2.1%
G93.89
Other specified disorders of brain
070-072
2.0%
G31.9
Degenerative disease of nervous system, unspecified
056-057

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

70450 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 70450

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New

Column 1 CCI Edits for 70450
Denied Codes (1)
Effective
Modifier
Accepted (2)
01922 ANESTH CAT OR MRI SCAN
07/01/2002 No
36591 DRAW BLOOD OFF VENOUS DEVICE
10/01/2015 No
36592 COLLECT BLOOD FROM PICC
10/01/2015 No
70480 CT ORBIT/EAR/FOSSA W/O DYE
04/01/1997 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
70481 CT ORBIT/EAR/FOSSA W/DYE
01/01/1996 Yes
70482 CT ORBIT/EAR/FOSSA W/O&W/DYE
01/01/1996 Yes
76380 CAT SCAN FOLLOW-UP STUDY
10/01/2009 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 70450.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for 70450

Denied Codes (1)
Effective
Modifier
Accepted (2)
70460 CT HEAD/BRAIN W/DYE
01/01/1996 No
70470 CT HEAD/BRAIN W/O & W/DYE
01/01/1996 No
70496 CT ANGIOGRAPHY HEAD
01/01/2010 Yes
77301 RADIOTHERAPY DOSE PLAN IMRT
01/01/2002 Yes
78811 PET IMAGE LTD AREA
10/01/2005 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
78812 PET IMAGE SKULL-THIGH
10/01/2005 Yes
78813 PET IMAGE FULL BODY
10/01/2005 Yes
78814 PET IMAGE W/CT LMTD
10/01/2005 Yes
78815 PET IMAGE W/CT SKULL-THIGH
10/01/2005 Yes
78816 PET IMAGE W/CT FULL BODY
10/01/2005 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 70450.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


2018 Medically Unlikely Edits for 70450


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 3 3 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Nature of Service/Procedure Nature of Service/Procedure Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   70450 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
RAMI KAAKAJI -YPSILANTI,MI 2,358
HOWARD SEIGERMAN -WALDWICK,NJ 2,330
ELLIOT LERNER -WALDWICK,NJ 2,311
WILLIAM HOLLOWAY -SAINT LOUIS,MO 2,201
RAYMONDA STEVENS -LEXINGTON,KY 2,115

   70450 Top 5 Ordering Organizations National*
GARFIELD IMAGING CENTER A CALIFORNIA PARTNERSHIP-CA 514
MISSION IMAGING SERVICES, LLC-NC 414
GATEWAY DIAGNOSTIC IMAGING, LLC-TX 387
LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.-SC 353
SWDIC IMAGING CENTER PARTNERSHIP, LLP-TX 352

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 70450*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2017: 6,252,636
Total Services Denied 2017: 415,425 (6.6%)
National Charges Submitted 2017: $1,231,185,271.72
National Charges Allowed 2017: $262,374,233.87
National Average (No Modifier) Fee Submitted 2017: $650.27
National Average (No Modifier) Fee Allowed 2017: $121.35
National Average (26) Fee Submitted 2017: $183.74
National Average (26) Fee Allowed 2017: $ 43.14
National Average (TC) Fee Submitted 2017: $622.09
National Average (TC) Fee Allowed 2017: $ 68.04


Top 5 Performing Specialties 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 6,035,032 96.5% $192.30 397,972 6.6%
Interventional radiology
(eff 5/92)
117,278 1.9% $185.28 7,388 6.3%
Independent Diagnostic Testing Facility
(IDTF)
(eff. 6/98)
30,915 0.5% $854.59 3,112 10.1%
Neurology 10,295 0.2% $269.76 1,399 13.6%
Internal medicine 10,129 0.2% $409.65 794 7.8%

Top 5 Places of Service 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Emergency room - hospital 3,554,345 56.8% $182.68 252,245 7.1%
Inpatient hospital 1,721,678 27.5% $183.55 106,066 6.2%
On Campus-Outpatient Hospital 712,698 11.4% $189.98 39,214 5.5%
Office 212,598 3.4% $546.45 15,225 7.2%
Off Campus- Outpatient Hospital 38,672 0.6% $188.49 1,337 3.5%

Top 5 Modifiers Submitted 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 6,072,299 97.1% $183.74 401,138 6.6%
No Modifier 117,115 1.9% $650.27 9,678 8.3%
TC - Technical Component 37,243 0.6% $622.09 3,146 8.4%
51 - Multiple Procedures 12,246 0.2% $638.99 146 1.2%
CT 5,756 0.1% $602.32 419 7.3%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


   CodeMap Compliance Briefings: Hide this section.

CMS Transmittals Referencing "70450"
Issue DateTransmittalTitle
2018-03-02 R2040OTN Appropriate Use Criteria for Advanced Diagnostic Imaging – Voluntary Participation and Reporting Period - Claims Processing Requirements – HCPCS Modifier QQ
2017-12-22 R3941CP January 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS)
2017-07-28 R3820CP Payment Reduction for X-Rays Taken Using Computed Radiography


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10/19/2018 10:50:07 54.224.150.24

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