CPT 71250Radiology

Ct thorax dx c-

CPT code 71250 covers a CT scan of the chest performed without contrast dye. This is a diagnostic imaging test that creates detailed cross-sectional pictures of the lungs, heart, blood vessels, and other chest structures.

Showing rates for

National Average

Base Medicare rate

$131.00

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

1.08

PE RVU (NF)

2.91

MP RVU

0.06

Total RVU

4.05

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

NCCI bundling edits

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Billing tips

Verify contrast administration status before code selection - distinguish between 71250 (no contrast), 71260 (with contrast), and 71270 (without and with contrast)
Impact: Code confusion between these three codes represents the highest denial risk. 71260 reimburses approximately $30-40 more but requires documented contrast administration and medical necessity for contrast.
Document medical necessity clearly in the ordering physician's notes, specifying why non-contrast study is appropriate for the clinical indication
Impact: Non-contrast studies may face medical necessity denials if clinical indication typically requires contrast (e.g., pulmonary embolism evaluation). Clear documentation prevents 15-20% of denials.
For screening purposes (lung cancer screening), use appropriate screening code (71271) instead of 71250 to ensure proper reimbursement and avoid denials
Impact: 71271 has different coverage criteria and may have different reimbursement. Billing 71250 for screening purposes will result in denial or recoupment.
Split bill professional and technical components (modifiers 26 and TC) only when services are performed at different entities to maximize compliant reimbursement
Impact: Global billing (no modifier) yields $131. Improper component billing can trigger audits. Ensure contractual arrangements support split billing before using modifiers.
Bundle bilateral chest imaging into single 71250 code - do not bill twice or use modifier 50 for bilateral procedures
Impact: 71250 is inherently bilateral. Billing twice results in denial of duplicate claim and potential audit flag for upcoding attempts.

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Frequently asked questions

What is the difference between CPT 71250 and 71260?

CPT 71250 is a CT scan of the chest performed without intravenous contrast material, while 71260 is performed with contrast. The choice depends on clinical indication: non-contrast (71250) is typically used for lung parenchyma evaluation, nodule assessment, and interstitial disease, while contrast (71260) is used for vascular assessment, mediastinal masses, and infection evaluation. The 2025 Medicare rate for 71250 is $131 versus approximately $165 for 71260.

How much does Medicare pay for CPT code 71250 in 2025?

Medicare pays $131 for CPT 71250 in 2025 based on the national average rate (both facility and non-facility rates are the same). This is calculated from 4.05 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic location due to locality adjustments and by payer contract terms for commercial insurance.

Can CPT 71250 and 71260 be billed together on the same date of service?

Generally no - you should use CPT 71270 (CT thorax without contrast followed by with contrast) when both non-contrast and contrast phases are performed during the same session. Billing both 71250 and 71260 separately will typically result in denial unless they represent completely separate studies performed for distinct clinical indications with modifier 59 and exceptional documentation supporting medical necessity for both.

What diagnosis codes support medical necessity for CPT 71250?

Common supporting diagnosis codes include solitary pulmonary nodule (R91.1), interstitial pulmonary disease (J84.9), abnormal chest X-ray findings (R91.8), hemoptysis (R04.2), chronic cough (R05.3), pneumonia (J18.9), and lung cancer history (Z85.118). The specific ICD-10 code must match the clinical indication documented in the ordering physician's notes. Payers may have Local Coverage Determinations (LCDs) specifying covered indications.

Do I need to use modifier 26 or TC when billing CPT 71250?

Only use modifier 26 (professional component) or TC (technical component) when the service is split between two entities - for example, when a hospital performs the scan (bills with TC) and a separate radiology group provides the interpretation (bills with 26). If one entity performs both the technical and professional services, bill the global code 71250 without modifiers. The global payment of $131 includes both components.

Is CPT 71250 appropriate for lung cancer screening?

No - lung cancer screening requires CPT 71271 (low dose CT for lung cancer screening), not 71250. Code 71271 has specific coverage criteria including age 50-80, smoking history of 20 pack-years, and current smoker or quit within past 15 years. Billing 71250 for screening purposes will result in denial. Use 71250 only for diagnostic studies with specific clinical indications or symptoms.

What are the RVU values for CPT 71250 in 2025?

CPT 71250 has 4.05 total RVUs in 2025, consisting of 1.08 work RVUs, 2.91 practice expense RVUs (both facility and non-facility settings have the same PE RVU for this code), and 0.06 malpractice RVUs. These RVUs multiplied by the 2025 conversion factor of 32.3465 yield the $131 Medicare payment rate.