CPT CODE and Description
71010 - Radiologic examination, chest; single view, frontal - Fee amount $20 - $26
71015 - Radiologic examination, chest; stereo, frontal
71020 - Radiologic examination, chest, 2 views, frontal and lateral; Fee amount $27 - $35
71021 - Radiologic examination, chest, 2 views, frontal and lateral; with apical lordotic procedure
71022 - Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections
71023 - Radiologic examination, chest, 2 views, frontal and lateral; with fluoroscopy
71030 - Radiologic examination, chest, complete, minimum of 4 views; - Fee amount $35,- $45
71034 - Radiologic examination, chest, complete, minimum of 4 views; with fluoroscopy
71035 - Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)
Indications and Limitations of Coverage and/or Medical Necessity
Note: Providers should seek information related to National Coverage Determinations (NCD) and other Centers for Medicare & Medicaid Services (CMS) instructions in CMS Manuals. This LCD only pertains to the contractor's discretionary coverage related to this service.
Radiologic examination of the chest (chest X-ray) facilitates the detection, diagnosis, staging and management of pathophysiologic processes involving thoracic, cardiovascular, pulmonary and mediastinal structures, contiguous coverings and the bony thorax. These examinations are covered by Medicare when medically necessary and appropriate for evaluation and management of a specific symptom, sign, disease or injury.
Chest X-rays are utilized in a variety of clinical states.
Generally accepted medical diagnoses are enunciated as Covered ICD-10 Codes (Covered Codes). Noridian Administrative Services will utilize these Covered Codes, and medical consultation, to assess medical necessity and appropriate utilization.
Routine, screening, pre operative or periodic examinations in the absence of symptoms, signs or disease states as represented by Covered ICD-10-CM Codes will not be reimbursed [Section 1862(a)(1)(A) of the Social Security Act].
Following a stable chronic condition, generally one examination in a twelve-month period will be considered appropriate. In acute or subacute conditions or when new symptoms or findings are documented, more frequent examinations will be considered for reimbursement and are subject to medical necessity review.
Submission with a Covered Code does not, a priori, equate with reimbursement. Clinical setting and examination frequency will also be assessed.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12 - Hospital Inpatient (Medicare Part B only)
13 - Hospital Outpatient
22 - Skilled Nursing - Inpatient (Medicare Part B only)
23 - Skilled Nursing - Outpatient
85 - Critical Access Hospital
Helpful Hints for Billing
The following example indicates the appropriate use of modifier 59 when two procedures codes that are not ordinarily performed together on the same day by the same provider, are reported.
• A single view chest x-ray (71010) is part of the more comprehensive radiologic exam described by 74022 (radiologic examination abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest). If these two procedures are reported together, 71010 will be denied separate reimbursement.
• When a single view chest x-ray is performed on the same day but at a different time and patient encounter, appending modifier 59 to CPT 71010 is warranted to signify that a separate and distinct service was performed. (Modifier 59 should follow modifier 26, if services are done in a facility setting.) Modifier 59 will override the procedure unbundling edit and 71010 will be eligible for separate reimbursement
** Always use Modifiers. For example for the CPT-4 code (chest-x-ray) 71010 use either modifier -26 or –TC to denote either the professional code or technical code.
** Pharmacy Providers may use Point of Sale
** Use website to view status of bill or authorization for services rendered: http//:owcp.dol.acs-inc.com
** Outpatient Hospital services can be billed on the UB 92 form with appropriate Revenue Center Codes requiring CPT/HCPCS codes.
** All bills must contain the DEEOIC’s 9-digit case number of your patient or client and your 9-digit provider number.
** Laboratory, x-ray, physical therapy, and clinical tests such as EKGs, etc. must be identified with the correct CPT code.
** Facility charges for ambulatory surgical center/outpatient surgery billing must be billed using the surgical CPT code. Modifier SG should be used.
** When billing for inpatient services, your Medicare number must be included.
*These procedures require pre-certification; call 1-877-PRE-AUTH
Physician Type CPT Codes Description
Primary Care Physicians: 71010-71030 Chest imaging
Cardiologists 71010-71030 Chest imaging
Pediatricians 71010-71030 Chest imaging
Pulmonologists 71010-71030 Chest Imaging
Reporting example:
For a single frontal chest x-ray, the claim for CPT code 71010 (Radiologic examination, chest; single view, frontal) would be submitted in one of the following two ways:
1. either as a global service, if the professional and technical components are submitted together:
** Global – 71010
2. or as individual claims for the professional and technical components, when submitted separately:
** Professional only – 71010-26 and
** Technical only – 71010-TC
Professional bilateral radiology services are reported as two lines with LT and RT modifiers
Radiology - Chest and rib X-ray
What is changing?
When CPT code 71010 and CPT code 71100 are billed for the same day, the codes will be recoded to the comprehensive CPT code or CPT code 71101.
** CPT code 71010 is defined as “radiologic examination, chest; single view, frontal.”
** CPT code 71100 is defined as ”radiologic examination, ribs, unilateral; two views.”
** CPT code 71101 is defined as “radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of three views.”
Why is Humana implementing this change?
CPT code 71010 is for a chest X-ray, and code 71100 is for rib views. If both views are being performed, the appropriate code to bill is code 71101, which is for the rib and chest views, per AMA’s CPT description.
71010 - Radiologic examination, chest; single view, frontal - Fee amount $20 - $26
71015 - Radiologic examination, chest; stereo, frontal
71020 - Radiologic examination, chest, 2 views, frontal and lateral; Fee amount $27 - $35
71021 - Radiologic examination, chest, 2 views, frontal and lateral; with apical lordotic procedure
71022 - Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections
71023 - Radiologic examination, chest, 2 views, frontal and lateral; with fluoroscopy
71030 - Radiologic examination, chest, complete, minimum of 4 views; - Fee amount $35,- $45
71034 - Radiologic examination, chest, complete, minimum of 4 views; with fluoroscopy
71035 - Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)
Indications and Limitations of Coverage and/or Medical Necessity
Note: Providers should seek information related to National Coverage Determinations (NCD) and other Centers for Medicare & Medicaid Services (CMS) instructions in CMS Manuals. This LCD only pertains to the contractor's discretionary coverage related to this service.
Radiologic examination of the chest (chest X-ray) facilitates the detection, diagnosis, staging and management of pathophysiologic processes involving thoracic, cardiovascular, pulmonary and mediastinal structures, contiguous coverings and the bony thorax. These examinations are covered by Medicare when medically necessary and appropriate for evaluation and management of a specific symptom, sign, disease or injury.
Chest X-rays are utilized in a variety of clinical states.
Generally accepted medical diagnoses are enunciated as Covered ICD-10 Codes (Covered Codes). Noridian Administrative Services will utilize these Covered Codes, and medical consultation, to assess medical necessity and appropriate utilization.
Routine, screening, pre operative or periodic examinations in the absence of symptoms, signs or disease states as represented by Covered ICD-10-CM Codes will not be reimbursed [Section 1862(a)(1)(A) of the Social Security Act].
Following a stable chronic condition, generally one examination in a twelve-month period will be considered appropriate. In acute or subacute conditions or when new symptoms or findings are documented, more frequent examinations will be considered for reimbursement and are subject to medical necessity review.
Submission with a Covered Code does not, a priori, equate with reimbursement. Clinical setting and examination frequency will also be assessed.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12 - Hospital Inpatient (Medicare Part B only)
13 - Hospital Outpatient
22 - Skilled Nursing - Inpatient (Medicare Part B only)
23 - Skilled Nursing - Outpatient
85 - Critical Access Hospital
Helpful Hints for Billing
The following example indicates the appropriate use of modifier 59 when two procedures codes that are not ordinarily performed together on the same day by the same provider, are reported.
• A single view chest x-ray (71010) is part of the more comprehensive radiologic exam described by 74022 (radiologic examination abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest). If these two procedures are reported together, 71010 will be denied separate reimbursement.
• When a single view chest x-ray is performed on the same day but at a different time and patient encounter, appending modifier 59 to CPT 71010 is warranted to signify that a separate and distinct service was performed. (Modifier 59 should follow modifier 26, if services are done in a facility setting.) Modifier 59 will override the procedure unbundling edit and 71010 will be eligible for separate reimbursement
** Always use Modifiers. For example for the CPT-4 code (chest-x-ray) 71010 use either modifier -26 or –TC to denote either the professional code or technical code.
** Pharmacy Providers may use Point of Sale
** Use website to view status of bill or authorization for services rendered: http//:owcp.dol.acs-inc.com
** Outpatient Hospital services can be billed on the UB 92 form with appropriate Revenue Center Codes requiring CPT/HCPCS codes.
** All bills must contain the DEEOIC’s 9-digit case number of your patient or client and your 9-digit provider number.
** Laboratory, x-ray, physical therapy, and clinical tests such as EKGs, etc. must be identified with the correct CPT code.
** Facility charges for ambulatory surgical center/outpatient surgery billing must be billed using the surgical CPT code. Modifier SG should be used.
** When billing for inpatient services, your Medicare number must be included.
*These procedures require pre-certification; call 1-877-PRE-AUTH
Physician Type CPT Codes Description
Primary Care Physicians: 71010-71030 Chest imaging
Cardiologists 71010-71030 Chest imaging
Pediatricians 71010-71030 Chest imaging
Pulmonologists 71010-71030 Chest Imaging
Reporting example:
For a single frontal chest x-ray, the claim for CPT code 71010 (Radiologic examination, chest; single view, frontal) would be submitted in one of the following two ways:
1. either as a global service, if the professional and technical components are submitted together:
** Global – 71010
2. or as individual claims for the professional and technical components, when submitted separately:
** Professional only – 71010-26 and
** Technical only – 71010-TC
Professional bilateral radiology services are reported as two lines with LT and RT modifiers
Radiology - Chest and rib X-ray
What is changing?
When CPT code 71010 and CPT code 71100 are billed for the same day, the codes will be recoded to the comprehensive CPT code or CPT code 71101.
** CPT code 71010 is defined as “radiologic examination, chest; single view, frontal.”
** CPT code 71100 is defined as ”radiologic examination, ribs, unilateral; two views.”
** CPT code 71101 is defined as “radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of three views.”
Why is Humana implementing this change?
CPT code 71010 is for a chest X-ray, and code 71100 is for rib views. If both views are being performed, the appropriate code to bill is code 71101, which is for the rib and chest views, per AMA’s CPT description.