cpt code 71250

(2022) CPT Code 71250 – Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 71250 is used to bill services when computed tomography (CT) of the chest/thorax is performed without using contrast medium.

CT scans use both X-rays and computer technology to view the detailed anatomy of the chest that is not normally visualized in a regular X-ray. This enables a better evaluation of the foreign body, trauma, and lesions.

CPT Code 71250 Description

CT chest can be performed by using contrast medium and without contrast medium. The Contrast medium aids to enhance the visualization of the chest to diagnose diseases that are unable to detect due to poor visibility.

This service, CPT 71250, is usually performed to identify pulmonary nodules, the abnormal finding of the chest, shortness of breath, atelectasis, Pneumothorax, COVID-19, traumatic injury of thoracic spine or chest and chest pain, etc.

The non-contrast CT will be better for the patients who have allergies to iodine-based contrast, and its cost is also lower comparatively with contrast study. Sometimes, patients need to be sedated to be placed in an immovable state. 

There are three types of CT scans of the chest that can be performed without contrast, with contrast, and without and with contrast. There are separate CPT codes for each type of CT scan.

For example, CPT 71250 will be reported if a chest CT scan is performed without contrast, while CPT 71260 will be billed if the study is performed with contrast. If both methods with and without contrast perform a CT scan of the chest, it will be reported with CPT code 71270.

cpt 71250

Reimbursement

A maximum of 1 unit of CPT 71250 can be billed on the same date of service, while three units can be billed if documentation supports the medical necessity. Modifier 26 and TC apply to this CPT 71250 for reimbursement purposes. The cost and RUVs of CPT 71250 are as follow:

CPT 71250 with modifier 26: (Facility Price: Cost $56.34 RUVS 1.62794) (Non-Facility Price: Cost $56.34 RUVS 1.62794)

CPT 71250 with modifier TC (Technical Component): (Facility Price: Cost $105.17 RUVS 3.0397) (Non-Facility Price: Cost $105.17 RUVS 3.0397)

CPT 71250 Global price (Without 26 and TC): (Facility Price: Cost $161.51 RUVS 4.66701 Non-Facility Price: Cost $161.51 RUVS 4.66701) 

71250

CPT Code 71250 Billing Guidelines

CPT code 71250 has technical and professional components. Therefore, it should be billed with an appropriate 26 or TC modifier. However, if the physician owns the practice, these modifiers TC and 26 are not required.

Documentation should support the medical necessity of service and be medically appropriate. The appropriate ICD 10 codes should be reported to the claims for reimbursement. The most billed ICD 10 codes are R07.9, J93.9, J98.4, I71.2, etc. 

Radiology services are typically performed without anesthesia then. Therefore, it is appropriate to bill with CPT code 01922.

If contrast is injected in combination with MRI cervical spine code, then it is appropriate to report with HCPCS level 2 codes Q9951 and Q9958–Q9967. While CPT code 71250 is performed without contrast. Therefore, there is no need to report these codes with CPT code 71250.

If contrast is injected via any other route such as intrathecal except intravenous or intraarticular route will be not considered as contrast study, then it appropriate to bill with non-contrast CPT code 71250 instead 71260 with contrast codes.

CPT 72141 is allowed to be billed together on the same date of service as CPT code 71270 according to NCCI (National Correct Coding Initiative).

Therefore, only CPT 71270 will be reported due to higher pay. In addition, CPT 71250 can be billed in combination with CPT code 71260 with the appropriate modifier. 

If CT of the chest is performed with high resolution, it is appropriate to report CPT code 71250 with modifier 22. The high resolution is not included in the CPT code 71250.

If 3D services are performed along with CPT 71250, this service will be separately reported with CPT code76376 or CPT code 76377.

If CT heart (75771-75574) is performed in combination with CPT code 71250, it is appropriate to bill separately with the appropriate modifier according to NCCI.

If CT Breast (0633T-0638T) is performed in combination with CPT code 71250, it is not appropriate to bill separately according to NCCI. Only CPT code 0633T will be billed due to higher pay.

CPT Code 71250 Modifiers

The following list contains modifiers that are applicable with CPT 71250:

  • 22, 23, 26, 51, 52, 53, 59, 76, 77, 78, 79, 99, AQ, AI, AR, CC, CR, ET, EY, FX, FY, GA, GC, GJ, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, QQ, SG, TC, XE, XS, XP, and XU.

The most frequently used modifiers are 26, TC, 77, 76, 59, or X {E, P, S, U} with CPT 71250. Modifier 26 is used to indicate the professional services or equipment, and applicable with CPT 71250 when CT of chest/ Thorax is performed by the physician in a hospital or not owned the equipment used in of chest/ Thorax or employee in the Facility.

At the same time, modifier TC indicates technical components such as machinery used in the CT chest (71250). It would be reported by Hospital or third party who owned the equipment.

CPT 71250 will be globally billed when CT of chest/ Thorax is performed in a private office, or the physician owns the equipment. Globally billed means without modifier 26 or TC. 

If CT of chest/Thorax is performed twice by the same physician on the same date of service, then CPT 71250 would be reported with Modifier 76.

At the same time, CT of chest/Thorax performed by a different physician on the same day it appropriate to attach modifier 77 with CPT 71250.

Modifier 59 is applicable with CPT 71250 when service is not normally performed together on the same date of service but bundled with other procedures. For further specifications, Medicare accepts modifiers XU, XE, XP, and XS instead of modifier 59 with CPT 71250.

Modifier Q6 is applicable with CPT 71250 for locum tenants billing or temporary substitute physician. Suppose the radiologist is on leave or absent from an original physician.

In that case, services are provided by the temporary physician or substitute physician with modifier Q6 under the name of the original provider, not with Loum tenant. 

Modifier 53 applies to CPT 71250 when the physician terminated the procedure due to unavoidable circumstances and plans to repeat the procedure in the future.

In contrast, modifier 52 will be attached to the CPT 71250 if the procedure is performed incompletely by the physician and does not have a plan to repeat the procedure. 

71250 cpt

CPT 72141 Examples

The following clinical examples are when CPT code 71250 may be used.

Example 1

A 35-year-old male without prior medical history presented to the emergency department with c/o constant midsternal chest pain two days ago, intermittent chest pain today, pressure-like sensation with intermittent shortness of breath.

The patient denies any pain currently. The patient thought it was related to the digestive system and took some medication for digestion.

Denies trauma, heavy lifting, palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, recent antibiotic use, near-syncope, or syncope, changes in stool color, urinary complaints, or any other symptoms.

The patient did not take any medication for pain. The patient vapes and drinks alcohol on occasion denies illicit drug use. The physician ordered a CT scan of the chest, cardiac profile, and Laboratory studies.

Example 2

A 49-year-old male presents to the office with no past medical and family history for the follow-up of pulmonary nodules. The patient denies any chest pain, headache, numbness, tingling, urinary problem, nausea, vomiting, and diarrhea.

Physical exam revealed an unremarkable study of all the other systems. Physicians ordered a CT chest, X-ray, and lab test to evaluate pulmonary nodule.

CT chest revealed multiple pulmonary nodules in the chest with other abnormal findings. The physician prescribed medicine and consulted with the pulmonologist, and he suggested doing a biopsy of these pulmonary nodules for further treatment.

Example 3

A 66-year-old male presents to the emergency department with syncope. A 2-days ago patient felt weakness and body aches. He took Tylenol for pain and felt better, but he was doing his normal activity today and suddenly passed out.

The patient could not obtain a review of the system (ROS), and a physical exam revealed abnormal findings of the heart and swelling in both extremities suggesting edema.

Physicians ordered a series of diagnostic tests such as EKG, CT, and chest MRI. The physician consulted with the cartologist for treatment and medication purposes. The patient condition gets stable after treatment, and sent home today after 3 to 4 hours of observation.

Is CPT Code 71250 The Same As G0297?

HCPCS code G0297 was deleted on January 1, 2021. It was effective for the services performed before January 1, 2021. The new CPT code is 71271.

These CPT codes (71271, or G0297) are used to bill for low dose CT screening of lung cancer, while CPT 71250 is used for billing a diagnostic CT of the chest despite screening.

These services CPT 71271 or G0297 and 71250 services cannot be billed together on the same date of service, CPT 71271 or G0297 can only bill once per year or check the appropriate third-party or payer guidelines.

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