CPT 70490Radiology

Ct soft tissue neck w/o dye

CPT code 70490 covers a CT scan of the soft tissues in the neck performed without using contrast dye (injectable material that makes structures more visible on imaging).

Showing rates for

National Average

Base Medicare rate

$147.82

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

1.28

PE RVU (NF)

3.22

MP RVU

0.07

Total RVU

4.57

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

NCCI bundling edits

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Billing tips

Verify correct code selection: 70490 is WITHOUT contrast; 70491 is WITH contrast; 70492 is without followed by with contrast. Using wrong code causes immediate denial.
Impact: Incorrect code selection results in 100% denial or significant payment variance ($147.82 vs $198+ for contrast studies)
Document medical necessity explicitly - link to specific signs/symptoms (neck mass, dysphagia, stridor, suspected abscess) rather than screening
Impact: Lack of medical necessity is the #1 denial reason; proper documentation prevents $147.82 denial and audit recoupment
For hospital billing, confirm registration status (inpatient vs outpatient) as this affects place of service coding but not the facility rate ($147.82 is same)
Impact: Incorrect place of service coding triggers claims rejection; both settings reimburse at $147.82 but require different revenue codes
When billing with modifier 26, ensure the facility is billing TC to avoid duplicate global billing; coordinate with imaging center
Impact: Double-billing global service results in overpayment recovery and potential fraud investigation
Check if prior authorization was obtained before service; many commercial payers require pre-certification for advanced imaging
Impact: Missing prior auth causes denial of entire $147.82 even with perfect coding; retrospective appeals rarely successful
Bill promptly within 90 days for Medicare and within payer-specific timely filing limits (often 180-365 days for commercial)
Impact: Timely filing denials are non-appealable; late submission forfeits entire $147.82 reimbursement

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 70490 in 2025?

The 2025 Medicare national average reimbursement for CPT 70490 is $147.82 for both facility and non-facility settings. This rate is based on 4.57 total RVUs multiplied by the 2025 conversion factor of 32.3465. Local Medicare Administrative Contractors (MACs) may have slight geographic variations based on locality adjustments.

What is the difference between CPT 70490 and 70491?

CPT 70490 is a CT of the soft tissue neck WITHOUT contrast material, while CPT 70491 is WITH intravenous contrast. Code selection depends on whether contrast dye was administered. Using 70490 when contrast was given constitutes incorrect coding and will result in claim denial or underpayment, as contrast studies have higher reimbursement rates.

How many RVUs is CPT code 70490 worth?

CPT 70490 has 4.57 total RVUs for 2025, comprised of 1.28 Work RVUs, 3.22 Practice Expense RVUs (both facility and non-facility), and 0.07 Malpractice RVUs. The identical PE RVU for both settings reflects that this procedure requires the same expensive CT equipment regardless of location.

Does CPT 70490 require prior authorization?

Medicare typically does not require prior authorization for 70490, but many Medicare Advantage and commercial insurance plans do require pre-certification for advanced imaging including CT scans. Requirements vary by payer and plan. Always verify authorization requirements before scheduling to avoid claim denials.

Can I bill CPT 70490 with a modifier 26 for professional component only?

Yes, modifier 26 is appropriate when the radiologist provides only the interpretation and does not own the CT equipment. The facility separately bills the technical component (modifier TC). When billing globally (both professional and technical components), no modifier is needed. Ensure coordination to prevent duplicate billing.

What diagnosis codes support medical necessity for CPT 70490?

Common supporting diagnoses include neck mass (R22.1), dysphagia (R13.10), thyroid nodule (E04.1), lymphadenopathy (R59.0), stridor (R06.1), suspected abscess (L02.11), post-operative complications, and trauma. Screening or routine follow-up without symptoms typically does not meet medical necessity criteria and will be denied.

How often can CPT 70490 be billed for the same patient?

There is no specific Medicare frequency limit for 70490, but medical necessity must be established for each study. Repeat imaging within short timeframes requires documentation of interval change in symptoms, treatment response assessment, suspected complication, or new clinical indication. Multiple studies without clear justification trigger audits and denials.