CPT 70488Radiology

Ct maxillofacial w/o & w/dye

CPT code 70488 covers a CT scan of the face and jaw area performed twice: first without contrast dye, then with contrast dye injected to highlight blood vessels and tissues for better imaging.

Showing rates for

National Average

Base Medicare rate

$181.14

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

1.27

PE RVU (NF)

4.25

MP RVU

0.08

Total RVU

5.6

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

NCCI bundling edits

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Billing tips

Document medical necessity for dual-phase imaging specifically - explain why both non-contrast and contrast phases are required rather than coding 70486 (without) or 70487 (with only)
Impact: Prevents downcoding to 70487 which reimburses approximately $30-40 less; reduces denial rate by 35%
Verify contrast administration is documented in radiology report with type, amount, and route - payers audit contrast billing heavily
Impact: Missing contrast documentation results in automatic downcoding to 70486 ($181.14 vs approximately $140), losing $40+ per claim
Split-bill 26/TC components when radiologist does not own equipment (hospital-based radiologists) to ensure proper reimbursement flow
Impact: Prevents payment delays and ensures correct party receives payment; hospital gets TC ($108.68) and physician gets 26 ($72.46)
Use diagnosis codes that clearly justify dual-phase imaging such as D49.0 (neoplasm), S02.4 (facial bone fracture), or J32.9 (chronic sinusitis) with complication codes
Impact: Reduces prior authorization denials by 40%; non-specific codes like R51 (headache) generate automatic denials
Check for recent prior authorization requirements - many commercial payers now require pre-auth for all contrast CT scans including 70488
Impact: Prevents 100% denial; retro-authorization attempts succeed only 15-20% of time, risking full $181.14 write-off
Bundle interpretation with same-day E/M only when documented as separate, distinct service with modifier 25 on E/M - never on imaging code
Improper modifier placement results in denial of entire E/M service (typically $75-150 loss in addition to imaging)

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 70488 in 2025?

The 2025 Medicare national average reimbursement for CPT 70488 is $181.14 for both facility and non-facility settings. This rate is based on 5.6 total RVUs multiplied by the 2025 conversion factor of 32.3465. Local rates may vary based on geographic practice cost indices (GPCI).

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

CPT 70486 is CT maxillofacial without contrast, 70487 is with contrast only, and 70488 is without contrast followed by with contrast (dual-phase). Code 70488 requires both non-contrast and contrast phases to be performed and documented, justifying the higher reimbursement for additional imaging and interpretation time.

How many RVUs is CPT code 70488 worth in 2025?

CPT 70488 has 5.6 total RVUs in 2025, consisting of 1.27 work RVUs, 4.25 practice expense RVUs (both facility and non-facility), and 0.08 malpractice RVUs. This RVU value reflects the dual-phase nature of the examination requiring both pre and post-contrast imaging.

Does CPT 70488 require prior authorization from Medicare or commercial insurance?

Medicare typically does not require prior authorization for 70488, but medical necessity must be documented. Many commercial payers and Medicare Advantage plans now require prior authorization for all contrast CT scans including 70488. Always verify payer-specific requirements before scheduling to prevent denials.

Can CPT 70488 be billed with modifier 26 for professional component only?

Yes, modifier 26 should be appended when the radiologist provides only the interpretation (professional component) without owning the equipment. This typically occurs in hospital settings where the facility bills the TC (technical component) separately. The 26 component represents approximately 40% of the total reimbursement.

What diagnosis codes support medical necessity for CPT 70488?

Strong supporting diagnoses include D49.0 (neoplasm of unspecified behavior), C76.0 (malignant neoplasm of head/face), S02.4XX (facial bone fractures), J32.x (chronic sinusitis with complications), M26.6 (TMJ disorders), and H05.x (orbital disorders). Weak diagnoses like R51 (headache) or R07.0 (facial pain) without additional specificity often trigger denials.

How should I bill if the patient cannot complete the contrast portion of CPT 70488?

If contrast cannot be administered due to patient reaction, renal insufficiency discovered during screening, or patient refusal after non-contrast images are complete, bill CPT 70486 (without contrast) instead. If the contrast portion is started but not completed, consider modifier 52 (reduced services) with 70488, though billing 70486 is typically more straightforward and less likely to be questioned.