CPT 70250Radiology

X-ray exam of skull

CPT code 70250 covers a standard x-ray examination of the skull, typically ordered to check for fractures, bone abnormalities, or other structural problems in the head bones.

Showing rates for

National Average

Base Medicare rate

$34.93

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

0.18

PE RVU (NF)

0.88

MP RVU

0.02

Total RVU

1.08

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Always verify whether billing global, professional (26), or technical (TC) component based on your practice setting and contractual arrangements
Impact: Incorrect component billing causes 30-40% of denials for 70250; can delay payment by 45-60 days during appeals
Document medical necessity clearly with specific ICD-10 codes - skull fracture (S02.x), head injury (S09.90XA), headache (R51.9), or other qualifying diagnoses
Impact: Vague or unrelated diagnosis codes account for 25% of denials; proper diagnosis coding ensures $34.93 payment versus $0
Bill 70250 only for complete skull series; incomplete or limited views may require different coding (70220 for radiologic exam, skull; less than 4 views)
Impact: Overcoding from 70220 to 70250 triggers audits; undercoding costs approximately $10-15 per encounter in lost revenue
Do not unbundle 70250 with facial bone x-rays (70140-70170) unless anatomically distinct and separately documented with modifier 59
Impact: CCI edits will automatically deny bundled claims; improper modifier 59 use risks audit and potential recoupment
For Medicare patients, obtain Advanced Beneficiary Notice (ABN) if medical necessity is questionable or indication does not meet LCD criteria
Impact: Without ABN, you cannot bill patient for denied services; proper ABN allows patient billing of $34.93 if Medicare denies
Ensure radiology report is finalized and signed before claim submission; unsigned or preliminary reports trigger medical review
Impact: Delayed or missing reports cause payment holds; 15-20% of audited claims fail due to incomplete documentation at time of billing

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 70250?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 70250 in 2025?

The 2025 Medicare national average payment for CPT 70250 is $34.93 for both facility and non-facility settings. This is based on 1.08 total RVUs (0.18 work RVU, 0.88 PE RVU, 0.02 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Does CPT 70250 require a modifier for the professional component?

Yes, when billing only the radiologist's interpretation, append modifier 26 to CPT 70250. The technical component (equipment and technologist) should be billed separately with modifier TC. If your facility provides both components, bill the global service without modifiers.

Can CPT 70250 be billed with facial bone x-rays on the same day?

Generally no, unless the skull and facial imaging are for distinct anatomical areas with separate clinical indications. CCI edits may bundle these services. If truly separate and medically necessary, modifier 59 may be appropriate with clear documentation of medical necessity for each distinct service.

What diagnosis codes support medical necessity for CPT 70250?

Common supporting diagnoses include skull fracture (S02.x codes), head injury (S09.90XA), post-traumatic headache, suspected skull abnormalities, follow-up of known lesions, evaluation of metabolic bone disease affecting skull, and certain congenital conditions. Vague headache codes alone may not meet LCD criteria without additional supporting documentation.

How many views are required to bill CPT 70250?

CPT 70250 represents a complete skull x-ray examination typically requiring at least 3-4 views (commonly AP, lateral, and Towne projections). If fewer than the standard views are obtained, CPT 70220 (skull x-ray, less than 4 views) may be more appropriate. Document all views obtained in the technical report.

What is the RVU value for CPT 70250 in 2025?

The total RVU for CPT 70250 in 2025 is 1.08, consisting of 0.18 work RVU, 0.88 practice expense RVU (both facility and non-facility), and 0.02 malpractice RVU according to the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Do I need prior authorization for CPT 70250?

Prior authorization requirements vary by payer and state. Medicare generally does not require prior authorization for skull x-rays, but some Medicare Advantage plans do. Commercial payers increasingly require authorization for all advanced imaging. Always verify specific payer requirements before service to avoid denial of the $34.93 reimbursement.