CPT 70260Radiology

X-ray exam of skull

CPT code 70260 covers a diagnostic X-ray examination of the skull, typically involving multiple views to evaluate bone structure, fractures, or abnormalities. This is a standard radiological procedure used to assess head injuries, bone diseases, or congenital conditions.

Showing rates for

National Average

Base Medicare rate

$43.34

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)

1.04

MP RVU

0.02

Total RVU

1.34

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

NCCI bundling edits

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Billing tips

Verify the number of views documented matches a complete skull series (typically 4+ views) versus limited study (70250, 1-2 views)
Impact: Prevents downcoding from 70260 ($43.34) to 70250 (lower reimbursement), protecting approximately $10-15 in revenue per study
Submit separate claims with modifier 26 and TC when professional and technical services are performed by different entities
Impact: Ensures both components are reimbursed correctly; failure to split can result in 50% payment loss for one party
Document medical necessity clearly, especially for non-trauma indications, as skull X-rays are often replaced by CT in modern protocols
Impact: Reduces denial rate by approximately 30-40%; many payers question skull X-rays when CT is the standard of care
Do not bill 70260 with CT or MRI of the head on the same date unless distinct clinical indications are documented separately
Impact: Prevents bundling denials and potential fraud flags; skull X-ray is typically considered inclusive when advanced imaging is performed
For hospital outpatient departments, ensure facility fee is billed appropriately as both facility and non-facility rates are $43.34
Impact: While rates are equal for 70260, proper facility status reporting ensures accurate cost reporting and future rate setting
Check LCD/NCD policies for your MAC regarding skull X-ray coverage limitations, particularly for screening or routine follow-up
Impact: Prevents denials on 15-25% of claims submitted for non-covered indications like dementia workup or routine headache without trauma

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 70260 in 2025?

The 2025 Medicare national average reimbursement for CPT 70260 is $43.34 for both facility and non-facility settings. This rate is based on a total RVU of 1.34 (0.28 work RVU, 1.04 PE RVU, 0.02 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic location based on locality adjustments.

What is the difference between CPT 70250 and 70260?

CPT 70250 is a limited skull X-ray study consisting of fewer than 3 views, typically used for targeted evaluation of a specific area. CPT 70260 is a complete skull X-ray examination with a minimum of 3-4 views providing comprehensive evaluation of the entire cranium. The number of views documented in the radiology report determines which code to bill, with 70260 receiving higher reimbursement for the more comprehensive study.

Can CPT 70260 be billed with modifier 26 for professional component only?

Yes, modifier 26 should be appended to 70260 when billing only the professional component (interpretation and report) separately from the technical component. This is common when a radiologist interprets films taken at a different facility. The technical component would be billed separately with modifier TC by the facility that performed the imaging. Both components together equal the total $43.34 reimbursement.

How many views are required to bill CPT 70260 instead of 70250?

CPT 70260 requires a minimum of 3 views for a complete skull examination, though most complete skull series include 4 or more views (typically AP, lateral, Towne's, and other specialized projections). The exact number of views should be documented in the radiology report. If only 1-2 views are obtained, CPT 70250 (limited skull X-ray) is the appropriate code. Documentation must clearly specify all views obtained to support billing 70260.

Is CPT 70260 covered by Medicare for headache evaluation?

Medicare coverage for CPT 70260 for headache evaluation is limited and depends on specific clinical circumstances. Most Medicare Administrative Contractors (MACs) do not cover routine skull X-rays for chronic headache or migraine, as these conditions require clinical evaluation or advanced imaging (MRI/CT) rather than plain radiography. Coverage may be considered for headache associated with trauma, suspected skull lesion, or specific structural concerns. Always verify Local Coverage Determinations (LCDs) for your MAC and document clear medical necessity.

Can CPT 70260 and a head CT be billed on the same day?

Billing both CPT 70260 and head CT (70450-70470) on the same day is generally not supported by most payers unless there are distinct, separate clinical indications documented for each study. CT of the head provides superior diagnostic information and typically includes evaluation of skull bones, making skull X-rays redundant. If both are performed, documentation must clearly explain why the skull X-ray provided unique clinical information not obtained from the CT, or was performed for a completely different indication. Expect high scrutiny and potential denial.

What diagnosis codes support medical necessity for CPT 70260?

Common ICD-10 codes supporting 70260 include S02.0XXA-S02.92XA (skull fractures), S06.0X0A-S06.9X9A (intracranial injuries), R51.9 (headache with documented trauma or structural concern), M85.0-M85.9 (bone disorders of skull), Q75.0-Q75.9 (congenital skull malformations), and C41.0 (malignant neoplasm of skull bones). The diagnosis must support why skull X-ray specifically is medically necessary. Non-covered diagnoses typically include routine screening, dementia evaluation, and chronic headache without trauma or specific bone concern.