X-ray exam of jaw joint
CPT code 70328 covers X-ray imaging of the temporomandibular joint (TMJ), which is the jaw joint that connects your lower jaw to your skull. This diagnostic imaging helps doctors evaluate jaw pain, clicking, limited motion, or suspected TMJ disorders.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Always document whether one or both TMJ joints were imaged and append RT/LT modifiers for unilateral studies to prevent payer confusion
Impact: Reduces denial rate by approximately 15-20% by eliminating laterality documentation requests
Verify that the radiologist's interpretation specifically mentions both open and closed mouth views if performed, as this supports the medical necessity for 70328
Impact: Strengthens audit defense and reduces medical necessity denials by up to 25%
Do not bill 70328 with other jaw imaging codes (70100, 70110) on the same date of service unless anatomically distinct areas are imaged with modifier 59
Impact: Prevents automatic bundling denials that can delay payment by 30-45 days
For split billing arrangements, ensure modifier 26 or TC is appended correctly and verify contractual arrangements support component billing
Impact: Prevents overpayment recoupment and ensures accurate payment distribution between facility and professional services
Link appropriate ICD-10 codes for TMJ disorders (M26.6x series) or trauma (S03.4x series) to support medical necessity rather than general jaw pain codes
Impact: Increases first-pass payment rate by 10-15% with more specific diagnosis coding
Submit claims within 30 days of service as Medicare and most payers have strict timely filing limits for diagnostic imaging
Impact: Protects the full $33.32 reimbursement from timely filing denials that result in complete write-offs
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