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2025 CPT code 71260

Computed tomography (CT) scan of the thorax with contrast material.

Follow all applicable CPT coding guidelines and payer-specific guidelines.Consider modifier usage based on service provided (e.g., modifier 26 for professional component only).

Modifiers 26 (professional component), TC (technical component), and others may apply depending on the specific circumstances and payer requirements.

Medical necessity is established when a chest CT with contrast is indicated to assess for conditions such as lung cancer, pulmonary embolism, trauma, or other diseases of the thorax requiring detailed imaging with contrast enhancement.The ordering physician should document clinical findings supporting the need for the procedure.

The clinical responsibility involves patient positioning, contrast administration (intravenous injection), image acquisition and interpretation, and reporting of findings.

IMPORTANT:71250 (without contrast), 71270 (without contrast followed by contrast and further sections).Modifiers 26 (professional component) and TC (technical component) may be appended depending on payer policy and the services rendered.Separate billing for contrast material may be possible depending on payer guidelines (e.g., using HCPCS Level II codes).

In simple words: A CT scan of your chest uses X-rays and a computer to create detailed pictures of the organs and structures in your chest.A special dye (contrast) is injected into a vein to make the images clearer. The scan helps doctors diagnose chest problems.

This diagnostic procedure involves a computed tomography (CT) examination of the thorax using contrast material.The provider rotates an X-ray tube and detectors around the patient, generating cross-sectional images. After positioning the patient, intravenous contrast is administered, typically through an upper extremity vein. Multiple cross-sectional images of the thoracic region are acquired as the patient moves through the scanner. The provider then interprets the images, storing, reconstructing, and reproducing them for further evaluation as needed.

Example 1: A 60-year-old male presents with persistent cough and hemoptysis. A chest CT with contrast is ordered to evaluate for lung cancer., A 25-year-old female involved in a motor vehicle accident sustains chest trauma. A CT scan with contrast is performed to assess for internal bleeding or injury to thoracic organs., A 70-year-old patient with a history of heart failure is admitted to the hospital with shortness of breath.A chest CT with contrast is used to evaluate for pulmonary edema and other causes of respiratory distress.

Detailed clinical indication for the study, patient history, results of the CT scan (including image interpretation and findings), and any contrast material used (type and amount).

** Always consult the most recent CPT codebook and payer-specific guidelines for the most accurate and up-to-date information on coding and reimbursement.

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