CPT 70491Radiology

Ct soft tissue neck w/dye

CPT code 70491 represents a CT (computed tomography) scan of the soft tissues in the neck performed with contrast dye injected into a vein to highlight blood vessels, lymph nodes, and other structures.

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

1.38

PE RVU (NF)

4.14

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

Always verify contrast administration documentation is present in both technologist notes and radiologist report, specifically noting type of contrast, dose, route, and lack of adverse reaction
Impact: Missing contrast documentation results in automatic downcoding to 70490 (without contrast), reducing reimbursement from $181.14 to approximately $155, a loss of $26 per study
Ensure medical necessity documentation clearly states the clinical indication requiring contrast enhancement rather than non-contrast study, particularly for thyroid nodules, infection workup, or suspected malignancy
Impact: Prevents denial for lack of medical necessity which accounts for 18-22% of CT contrast study denials; successful appeal takes 45-60 days delaying payment
Bill with appropriate ICD-10 codes that justify contrast use such as R22.1 (localized swelling neck), C73 (thyroid malignancy), or D09.08 (carcinoma in situ larynx) rather than vague symptoms
Impact: Specific diagnosis coding reduces denial rate by 30-40% and eliminates need for additional documentation requests that delay payment by 2-3 weeks
Do not bill 70491 with 70490 (without contrast) or 70492 (without and with contrast) on same date for same anatomical area as these are mutually exclusive per NCCI edits
Impact: Prevents automatic denial of both codes and potential OIG audit flags; violating NCCI edits results in 100% denial requiring refund and rebilling
For facility billing, verify that contrast materials are not separately billable with HCPCS codes when performed with 70491 in outpatient hospital setting
Impact: Prevents overpayment recovery actions; contrast is included in the $181.14 technical component payment and separate billing triggers $50-200 recoupment per case during audits

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 70491 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 70491 is $181.14 for both facility and non-facility settings. This is based on 5.60 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 70490, 70491, and 70492?

CPT 70490 is CT neck without contrast, 70491 is CT neck with intravenous contrast (the code described here), and 70492 is CT neck without contrast followed by with contrast and further sections. The codes differ based on whether and how contrast material is used, with 70491 requiring only the contrast-enhanced portion while 70492 includes both non-contrast and contrast phases.

Does CPT 70491 require prior authorization from Medicare or commercial payers?

Medicare generally does not require prior authorization for 70491, though some Medicare Advantage plans do. Most commercial payers require prior authorization for CT studies with contrast, particularly for non-emergent indications. Emergency department studies typically have authorization requirements waived. Always verify with the specific payer before scheduling non-emergent studies.

Can CPT 70491 be billed with modifier 26 for professional component only?

Yes, modifier 26 can be appended to 70491 when billing only the professional component (radiologist interpretation). This is common when a radiologist interprets a study performed at a different facility. The professional component represents approximately 40% of the total reimbursement, or about $72 of the $181.14 total payment.

What diagnosis codes support medical necessity for CPT 70491?

Common supporting diagnosis codes include R22.1 (localized neck swelling), C73 (malignant neoplasm of thyroid), C32.9 (larynx malignancy), J39.0 (retropharyngeal abscess), D44.0 (thyroid neoplasm of uncertain behavior), R19.09 (neck mass), and I77.89 (neck vascular disorders). The diagnosis must justify why contrast enhancement is medically necessary rather than a non-contrast study.

How many RVUs does CPT code 70491 have in 2025?

CPT 70491 has 5.60 total RVUs in 2025, consisting of 1.38 work RVUs, 4.14 practice expense RVUs (both facility and non-facility), and 0.08 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

What are the most common reasons for denial of CPT 70491 claims?

The most common denials include lack of documented medical necessity for contrast versus non-contrast study, insufficient documentation that contrast was actually administered, billing errors when combined with other CT neck codes (70490 or 70492) creating duplicate service denials, and missing prior authorization for non-emergent studies when required by the payer.