CPT 70200Radiology

X-ray exam of eye sockets

CPT 70200 covers an X-ray examination of the eye sockets (orbits), which are the bony cavities that hold and protect the eyes. This imaging helps doctors evaluate fractures, foreign objects, or structural abnormalities in the orbital bones.

Showing rates for

National Average

Base Medicare rate

$46.26

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.28

PE RVU (NF)

1.13

MP RVU

0.02

Total RVU

1.43

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Split bill professional and technical components when interpretation occurs at different facility than imaging
Impact: Prevents claim denials and ensures both facility and physician receive appropriate reimbursement of the full $46.26 split between components
Document number of views taken and medical necessity for bilateral imaging when both orbits are examined
Impact: Single code covers bilateral examination; billing twice without modifier 50 (not typically used for this code) results in downcoding and potential loss of 50% payment
Verify that CT orbit (70480-70482) was not performed same day before billing 70200
Impact: Medicare and commercial payers typically deny plain films when advanced imaging is performed; CT studies pay $150-300 and bundle plain films
Use specific ICD-10 codes indicating orbital trauma or foreign body rather than generic facial injury codes
Impact: Codes like S02.3 (orbital floor fracture) or S05.5 (penetrating wound with foreign body) support medical necessity and reduce denial risk by 30-40%
Ensure timely filing within 90-365 days depending on payer; Medicare requires filing within 365 days
Impact: Late filing is a non-appealable denial resulting in 100% loss of the $46.26 reimbursement plus administrative costs
Include radiologist's signed and dated written report with claim for initial submissions to new payers
Impact: Reduces request for medical records and speeds payment by 15-20 days on average

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 70200 in 2025?

Medicare pays $46.26 for CPT 70200 in 2025 based on the national average non-facility rate. This applies to both facility and non-facility settings. The payment is based on 1.43 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Can CPT 70200 be billed bilaterally with modifier 50?

No, CPT 70200 is inherently a bilateral procedure that includes examination of both orbits when clinically indicated. Do not append modifier 50 or bill the code twice. Use modifiers RT or LT only when imaging truly one orbit, but documentation must support why bilateral imaging was not performed.

What is the difference between CPT 70200 and 70220?

CPT 70200 covers X-ray examination of the orbits (eye sockets), while CPT 70220 covers X-ray examination of the sinuses. Although anatomically adjacent, these are distinct structures requiring different views and clinical indications. Some payers may allow both on the same day with appropriate diagnosis codes and modifier 59.

How many RVUs is CPT code 70200 worth?

CPT 70200 has 1.43 total RVUs in 2025, consisting of 0.28 work RVUs, 1.13 practice expense RVUs, and 0.02 malpractice RVUs. The PE RVU is the same (1.13) for both facility and non-facility settings.

What diagnosis codes support medical necessity for CPT 70200?

Common supporting diagnosis codes include S02.3 (orbital floor fracture), S02.8 (other orbital fractures), S05.5 (penetrating wound of orbit with foreign body), H05.2 (exophthalmos), and H02.0 (entropion/ectropion). Trauma codes (S00-S09) and orbital disease codes (H05) typically meet medical necessity requirements.

Do I need prior authorization for CPT 70200?

Most Medicare and commercial payers do not require prior authorization for CPT 70200 due to its low cost and use in acute trauma settings. However, some managed care plans and workers' compensation carriers may require authorization. Always verify with the specific payer before performing non-emergent imaging.

Can CPT 70200 be billed with an E/M code on the same day?

Yes, CPT 70200 can be billed with an E/M service on the same day without modifier 25 because it is a diagnostic procedure, not a minor procedure. The E/M code should reflect the evaluation that led to ordering the orbital X-ray. Ensure documentation supports a separately identifiable E/M service beyond simply ordering the X-ray.