Coverage Indications, Limitations, and/or Medical Necessity

A cranial Computerized Tomographic (CT) Scan is a very useful and informative neurodiagnostic tool. Scanning of the head in successive layers by a narrow beam of x-rays enables the transmission of x-ray photons in each layer to be measured. A computer is used to process the accumulated x-ray photon data and constructs a graphic image of a tomographic slice. Normal intracranial structures and a wide variety of intracranial disorders may be demonstrated. A cranial CT scan may be ordered without Contrast (70450), with injection of standard roentgenographic Contrast Material (70460) or without contrast material, followed by contrast material and further sections (70470). Contrast administration is not without risk to the patient and for some conditions adds little or no benefit to the examination.

Cranial CT scans are determined to be reasonable and necessary and are a covered service when the patient has clinical evidence of an intracranial disorder or an established intracranial disorder or disease. The general indications for use of contrast CT scanning are:

1. to assess perfusion (e.g. CVA)

2. to characterize a specific lesion

3. to detect defects in blood/brain barrier (e.g. infarcts, tumors, infection, vasculitis)

4. to detect neovascularity (tumors); or

5. for staging of known lung cancer, breast cancer, and lymphomas which are likely to metastasize early to the brain


Bill Type Codes 
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

Bill Type Code Bill Type Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
071x Clinic - Rural Health
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital


CPT/HCPCS Codes 
Group 1: Paragraph

Group 1: Codes
Code Description
70450 COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL
70460 COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITH CONTRAST MATERIAL(S)
70470 COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS