CPT 70220Radiology

X-ray exam of sinuses

CPT code 70220 covers a standard x-ray examination of the sinuses, the air-filled spaces around your nose and eyes. This is a common diagnostic imaging test used to check for sinus infections, blockages, or structural problems.

Showing rates for

National Average

Base Medicare rate

$36.55

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

0.22

PE RVU (NF)

0.89

MP RVU

0.02

Total RVU

1.13

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

NCCI bundling edits

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Billing tips

Verify medical necessity with appropriate ICD-10 codes such as J01.xx (acute sinusitis), J32.xx (chronic sinusitis), or R51.9 (headache) to support the examination
Impact: Prevents medical necessity denials that account for 25-30% of 70220 claim rejections
Do not bill 70220 with 70210 (complete sinus series) on the same date of service; 70220 is a less extensive study and will be denied as inclusive
Impact: Prevents automatic denial and potential audit flags for unbundling
When performed in facility setting, verify place of service code matches claim type (facility vs. non-facility) as both have the same rate of $36.55 but incorrect POS codes trigger denials
Impact: Eliminates administrative denials requiring resubmission and delaying payment 30-45 days
For split billing scenarios, ensure modifier 26 or TC is appended correctly based on service ownership; global billing without modifiers when appropriate yields full $36.55
Impact: Incorrect modifier usage can result in 40-60% reduction in expected reimbursement
Document the specific views obtained (e.g., Caldwell, Waters, lateral) in the radiology report to support the examination extent and differentiate from limited studies
Impact: Strengthens medical record for audits and reduces downcoding risk during post-payment review
When billing with same-day E/M services, append modifier 25 to the E/M code (not to 70220) and ensure documentation clearly shows the separate identifiable service
Impact: Prevents bundling denials and preserves both the E/M reimbursement and the $36.55 imaging payment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 70220 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 70220 is $36.55 for both facility and non-facility settings. This is based on 1.13 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic location and MAC adjustments.

What is the difference between CPT 70220 and 70210?

CPT 70220 is a standard sinus x-ray examination with less than complete views, while CPT 70210 represents a complete paranasal sinus series requiring a minimum number of views. Code 70210 is more comprehensive and should not be billed together with 70220 on the same date of service.

Can CPT 70220 be billed with an office visit on the same day?

Yes, CPT 70220 can be billed with an E/M service on the same day if the E/M service is separately identifiable and documented. Append modifier 25 to the E/M code (not to 70220) and ensure documentation clearly shows the distinct evaluation that led to the decision to order the x-ray.

How many RVUs is CPT code 70220 worth?

CPT 70220 has a total of 1.13 RVUs for 2025, consisting of 0.22 work RVUs, 0.89 practice expense RVUs (both facility and non-facility), and 0.02 malpractice RVUs. These values are from the CMS Physician Fee Schedule RVU25A released December 23, 2024.

What diagnosis codes support medical necessity for CPT 70220?

Common supporting diagnoses include J01.xx (acute sinusitis), J32.xx (chronic sinusitis), J34.89 (nasal polyps), R51.9 (headache), S02.1xx (facial bone fractures), and R09.89 (facial pain). Documentation must support the clinical necessity for imaging based on symptoms, duration, and failed conservative management.

Do I need to use modifier 26 or TC when billing CPT 70220?

Use modifier 26 when billing only the professional component (physician interpretation), modifier TC for only the technical component (equipment/technologist), or no modifier for global billing when one entity owns the equipment and provides the interpretation. Incorrect modifier use can result in 40-60% underpayment.

Is prior authorization required for CPT 70220?

Prior authorization requirements vary by payer and state. Medicare generally does not require prior authorization for 70220, but some Medicare Advantage plans and commercial insurers may require it. Always verify specific payer requirements before performing the service to avoid denial for lack of authorization.