CPT code 70450 is for a CT scan of the head or brain performed without contrast material, used to diagnose conditions like trauma or stroke.
CPT code 70450 is used to describe a computed tomography (CT) scan of the head or brain performed without the use of contrast dye. This diagnostic imaging procedure is typically ordered to evaluate various conditions such as head injuries, headaches, dizziness, or to detect abnormalities like tumors, bleeding, or structural changes in the brain. The absence of contrast dye means that the scan relies solely on X-ray technology to produce detailed images of the brain's structure, which can be crucial for initial assessments or when contrast is contraindicated for the patient.
1. Modifier 26 (Professional Component): This modifier is used when the professional component of the service is being billed separately from the technical component. It is applicable when a physician interprets the results of the X-ray or CT scan, but the equipment and technical staff are provided by another entity.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It applies when the facility provides the equipment and technical staff for the X-ray or CT scan, but the interpretation is done by a different provider.
3. Modifier 59 (Distinct Procedural Service): This modifier may be used if the X-ray or CT scan is performed as a distinct service from other procedures on the same day. It indicates that the procedure is separate and not part of another service or procedure.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used if the X-ray or CT scan needs to be repeated on the same day by the same physician due to medical necessity.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if the X-ray or CT scan is repeated on the same day by a different physician, again due to medical necessity.
6. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for laboratory tests, this modifier can sometimes be applicable if the X-ray or CT scan is repeated for clinical reasons, not due to equipment malfunction or error.
7. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the full service was not performed.
8. Modifier 53 (Discontinued Procedure): This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
9. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. It indicates that the procedure was more complex or took more time than usual.
These modifiers help ensure accurate billing and reimbursement by providing additional information about the circumstances under which the X-ray or CT scan was performed.
CPT code 70450 is generally reimbursed by Medicare, as it is a common diagnostic procedure. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
The specific reimbursement amount can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting payment policies within their jurisdiction, so it is important for healthcare providers to verify the reimbursement details with their respective MAC to ensure accurate billing and payment for CPT code 70450.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 70450, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
