CPT 70486Radiology

Ct maxillofacial w/o dye

CPT code 70486 is used for a CT scan of the face and jaw area performed without contrast dye or injectable material. This imaging helps doctors see bones, sinuses, and soft tissues of the face to diagnose injuries, infections, or abnormalities.

Showing rates for

National Average

Base Medicare rate

$126.15

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

0.85

PE RVU (NF)

MP RVU

0.05

Total RVU

3.9

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

NCCI bundling edits

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Billing tips

Always verify the absence of contrast administration before billing 70486 instead of 70487 or 70488. Review the technologist notes and radiologist report to confirm no IV contrast was given.
Impact: Prevents denials and recoupment; incorrect code selection can result in $30-80 payment variance and payer audits
Document medical necessity clearly with specific ICD-10 codes for facial trauma (S02.x), sinusitis (J32.x), or dental pathology (K04.x). Generic symptoms like 'facial pain' alone may trigger prior authorization requirements.
Impact: Reduces denial rate by 35-40% and eliminates costly appeal processes; ensures first-pass payment of $126.15
Bill 70486 globally when performed in non-facility settings. Split into 26 and TC modifiers only when technical and professional components are performed by different entities or locations.
Impact: Proper modifier use prevents claim rejections; global billing receives full $126.15 versus split payments that must reconcile
Check payer-specific prior authorization requirements before performing the scan. Many commercial payers require pre-auth for CT imaging, even though Medicare typically does not for 70486.
Impact: Prevents 100% denial for no authorization; some payers automatically deny without pre-cert regardless of medical necessity
Document any repeat imaging on the same day with modifier 76 and clear clinical justification in the radiology report explaining why the initial scan was inadequate or clinical status changed.
Impact: Enables payment for medically necessary repeat scans that would otherwise be denied as duplicates, recovering additional $126.15

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 70486 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 70486 is $126.15 for both facility and non-facility settings. This is based on 3.9 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustments in your area.

What is the difference between CPT codes 70486, 70487, and 70488?

CPT 70486 is a CT scan of the maxillofacial area without contrast dye. CPT 70487 is the same scan performed with IV contrast material. CPT 70488 includes both non-contrast and contrast phases in a single session. The choice depends on clinical indication and whether contrast enhancement is needed to visualize specific pathology.

Does CPT 70486 require prior authorization from insurance?

Medicare typically does not require prior authorization for CPT 70486, but many commercial insurance plans and Medicare Advantage plans do require pre-certification for CT imaging. Always verify authorization requirements with the specific payer before scheduling the scan to avoid claim denials.

How many RVUs is CPT code 70486 worth in 2025?

CPT 70486 has 3.9 total RVUs in 2025, consisting of 0.85 work RVUs, 3.0 practice expense RVUs (both facility and non-facility), and 0.05 malpractice RVUs according to the CMS Physician Fee Schedule released December 23, 2024.

Can CPT 70486 be billed with an E/M visit on the same day?

Yes, CPT 70486 can be billed with an evaluation and management (E/M) code on the same day if the E/M service is separately identifiable and documented. The CT scan is a diagnostic procedure and does not bundle with E/M codes. Ensure the E/M documentation supports a distinct service beyond simply ordering the imaging study.

What diagnosis codes support medical necessity for CPT 70486?

Common supporting diagnosis codes include facial fractures (S02.x series), chronic sinusitis (J32.x), acute sinusitis complications (J01.x), dental abscess with bone involvement (K04.6, K04.7), facial trauma (S09.93XA), nasal obstruction (J34.89), and suspected maxillofacial neoplasms (D38.5, C41.0). The specific diagnosis must justify the need for CT-level imaging rather than plain radiographs.

Should I use modifier 26 or TC when billing CPT 70486?

Use modifier 26 when billing only the professional component (radiologist interpretation). Use modifier TC when billing only the technical component (equipment, technologist, supplies). Bill 70486 without modifiers (globally) when the same entity provides both components. Split billing is common when hospital provides technical component and radiologist group bills separately for interpretation.