CPT Code 70450: Description & Reimbursement Guidelines

Did you know that 93 million CT scans were performed in the U.S. in 2023 alone? These scans are capable of creating detailed, cross-sectional images of the body to enable physicians to identify issues, such as internal bleeding, tumors, and fractures. However, billing for these imaging procedures is not straightforward!

Thus, this guide will help you master billing for CPT code 70450, which covers a CT scan of the head or brain. So, if you want to understand where this imaging test applies, and how to ensure payment on the first try, continue reading till the end.

CPT Code 70450 – Description

CPT code 70450 covers a computed tomography (CT) scan of the brain or head without a contrast agent. Physicians typically order this diagnostic imaging procedure to identify any brain or intracranial abnormalities.

Appropriate Use Cases for CPT Code 70450

Here are some real-world clinical scenarios related to CPT 70450:

Hydrocephalus or Shunt Malfunction Evaluation

Picture a 20-year-old male patient with a history of a surgically placed ventriculoperitoneal (VP) shunt to manage excess brain fluid. He visits the clinic and complains of experiencing persistent lethargy and vomiting. 

The healthcare practitioner suspects shunt malfunction. Thus, he orders a non-contrast CT (CPT code 70450) to assess the ventricular size. Note that contrast is not needed to evaluate the basic placement of the shunt tubing or cerebrospinal fluid dynamics within the brain.

Chronic Headache or Sinusitis Screening

Assume a 44-year-old female patient with a history of chronic, localized headaches. The primary care physician believes these headaches are due to chronic fluid collection, an anatomical issue, or complicated sinusitis. Hence, the physician orders a CT scan without contrast to confirm the diagnosis.

Here, CPT code 70450 applies. Non-contrast CT scans are ideal for initial screening, such as chronic pathology evaluations. Besides, they provide sufficient tissue and bony details.

Acute Head Trauma and to Rule Out Hemorrhage

Imagine a 38-year-old male patient who comes to the emergency room following a fall. He explains that when he fell, he briefly became unconscious. However, after he gained consciousness, he was confused and had a persistent headache.

As a result, the referring physician orders a non-contrast CT scan (CPT code 70450) to rule out intracranial hemorrhage (brain bleed) or skull fracture. For context, a hemorrhage is a life-threatening emergency in which there is bleeding in the skull.

In CT scans without contrast, fresh blood shows as bright white, making it a gold standard for confirming hemorrhage.

Modifiers to Append with CPT Code 70450

Listed below are some of the applicable modifiers for CPT 70450:

Modifier 26

What happens when you perform only the interpretation of the CT scan? You append modifier 26 to highlight that you are billing only for the professional component of CPT code 70450.

Modifier 51

There may be circumstances where the same physician or a different practitioner from a group practice performs another diagnostic imaging service, along with CPT code 70450, in the same encounter for the same patient. When this happens, report the service with modifier 51 to indicate that multiple procedures were performed in the same session.

It will result in a 50% reduction of the technical component and 5% reduction of the professional component for the second imaging procedure.

Modifier TC

If you are a radiology center or a hospital that owns the equipment, supplies, and other resources required to perform the non-contrast CT scan, report modifier TC with CPT code 70450. It indicates that you are billing for the technical component of the service.

Reimbursement Guidelines for CPT Code 70450

Do you want to ensure rightful reimbursement every time you perform a non-contrast CT of the head or brain? If yes, below are the reimbursement guidelines to help you out:

Fulfill Documentation Requirements

Timely reimbursement against the CPT code 70450 requires complete and accurate documentation. Besides, there should be a correlation between the ordering healthcare practitioner’s notes and the final radiology report.

Ordering Physician’s Documentation

Here’s what the physician notes should include:

• Patient’s symptoms and physical exam findings, e.g., suspected hemorrhage, etc.
• The order must clearly specify a CT scan of the head or brain without using a dye agent.

Radiology Report and Technical Documentation

The following are the radiologist and imaging facility’s documentation requirements:

• The radiologist’s report must clearly state the clinical indication that aligns with the ordering physician’s stated reason.
• The report must mention that no contrast material was administered while performing the scan.
• The interpreting radiologist must provide a detailed assessment of the images.

Justify Medical Necessity

The primary determinant of reimbursement for all procedures is the same, i.e., demonstrating the medical necessity of the rendered service. So, if you do not want your claim against CPT code 70450 to result in a denial, explain why the non-contrast CT scan was appropriate for the patient’s condition. 

But how can you do it? By using appropriate ICD-10 diagnosis codes. Moreover, the ICD-10 code you use must align with the local coverage determinations (LCDs). Note that a CT scan without dye is generally performed for acute issues like stroke workups, trauma, etc. However, for non-emergent issues, you may need to acquire pre-authorization from the payer.

Append Appropriate Modifier for Component Billing

Since CPT code 70450 is a global procedure, it covers reimbursement for both the professional and technical components. Thus, when you want to report a single component, you must append the relevant modifier, i.e.,  26 and TC.

Final Thoughts on CPT Code 70450

Diagnostic imaging procedures, such as a non-contrast CT scan of the brain or head, are integral to confirm diagnosis in emergency situations. However, insurance payers want your documentation to be complete to justify the medical necessity of this procedure. 

In this guide, we tried to cover everything you need to know about billing CPT code 70450. We explained its descriptor, applicable modifiers, clinical scenarios, and reimbursement guidelines. However, if you still find it challenging, feel free to outsource radiology billing services to professionals like NeuraBill.

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