Top 15 Radiology CPT Codes and How to Use Them Correctly

Accuracy in radiology billing is not an option. Every CPT (Current Procedural Terminology) code has a direct impact on revenue, risk of noncompliance, and claim turnaround. Worse yet, even experienced coders and radiology groups miscue frequently used codes—resulting in denials, audits, and underpayment.

The 15 Most Common Radiology CPT Codes—and Instructions

The most common radiology CPT codes, best practices for their usage, and documentation necessities to ensure clean claims. These are not textbook guidelines but rather experience-driven advice stemming from two decades of audit billing, payer disputes, and EMR integrations.

1. 71045 – Chest X-Ray, Single View

Correct Use: Use this code when just a single frontal (PA or AP) chest view is performed. The medical need (e.g., cough, chest pain) should be clearly documented.

Avoid: Billing this when a lateral view is also obtained — in that situation, use 71046 instead.

2. 71046 – Chest X-Ray, Two Views

Correct Use: Apply when both frontal and lateral chest views are conducted. Make sure the report contains interpretation of both views.

Avoid: Applying the code for a single-view exam or presuming all chest X-rays require two views.

3. 72148 – MRI, Lumbar Spine Without Contrast

Correct Use: This is for a non-contrast lumbar spine MRI. Make sure ICD-10 diagnosis (e.g., M54.5 – low back pain) justifies the clinical necessity.

Avoid: Charging this when contrast is applied or if the order is for both cervical and lumbar MRI — billed separately.

4. 72141 – MRI, Cervical Spine Without Contrast

Proper Use: Utilize only when no contrast is given. Verify that the MRI order and radiology report are compatible with this criteria.

Avoid: Charging 72141 if any contrast is applied during the procedure — use 72156 instead.

5. 74177 – CT Abdomen and Pelvis With Contrast

Proper Use: Bill only when the abdomen and pelvis scans are both done in the same session with contrast.

Avoid: Billing for this when just one area is scanned, or when contrast isn't used for each.

6. 74176 – CT Abdomen and Pelvis Without Contrast

Proper Use: Bill only if both areas are scanned without contrast. Must be well documented.

Avoid: Billing this when contrast is administered or if only the abdomen is scanned.

7. 70450 – CT Head/Brain Without Contrast

Correct Use: Common for trauma or stroke. Must include clear clinical indications like head trauma, stroke, or seizure.

Avoid: Billing alongside brain MRI for the same reason on the same day without documentation to support both.

8. 77067 – Screening Mammography, Bilateral

Correct Use: Application for screening in routine asymptomatic women. Needs ICD-10 Z12.31 (breast cancer screening).

Avoid: Using the code for follow-up of abnormal results — then use 77066 or 77065.

9. 77063 – Digital Breast Tomosynthesis (Add-on)

Correct Use: Add-on to 77067. Only use when 3D tomosynthesis is being done as part of a screening mammogram.

Avoid: Billing as a standalone or with diagnostic mammography codes.

10. 73721 – MRI, Lower Extremity Without Contrast

Appropriate Use: Use when a non-contrast MRI of the lower extremity is done for lower limb pain, injury, or joint pathology.

Avoid: Billing this when contrast is administered — in that situation, use 73723.

11. 70553 – MRI Brain With and Without Contrast

Appropriate Use: Use only for when all three phases are done: pre-contrast, contrast injection, and post-contrast imaging.

Avoid: Billing this if only one or two of the phases are performed — bill 70551 or 70552 accordingly.

12. 76641 – Total Ultrasound of Breast

Correct Use: Bill this code when all quadrants of the breast and retroareolar area are scanned.

Avoid: Billing this for a focused or single-region exam — bill 76642 instead.

Breast ultrasound coding guidance – ACR

13. 73221 – MRI, Upper Extremity Without Contrast

Correct Use: Applied to shoulder, arm, or wrist pain. Make sure right or left side is noted, along with supporting diagnosis.

Avoid: Billing this for bilateral studies withoutmodifiers RT/LT or noting multiple units.

14. 76856 – Pelvic Ultrasound, Non-Obstetric, Complete

Correct Use: Covers uterus, ovaries, adnexa, and pelvic structures. Must be completely documented.

Avoid: Using this for limited or bladder-only exams — use 76857 in that case.

15. 73700 – CT Lower Extremity Without Contrast

Proper Use: Use in trauma or vascular studies without contrast. Very common in ER and ortho.

Avoid: Billing with contrast or for areas other than extremities (e.g., pelvis or abdomen).

Coding with Modifiers: A Quick Reminder

• -26: Professional component (use when you only interpret the image)

• -TC: Technical component (use when you only take the test)

• -59: Distinct procedural service (only if services are separate and unrelated)

• RT/LT: To be applied on extremity or breast imaging laterality

The Significance of Specialty Billing

Radiology has special CPT modifiers, compliance hazards, and bundling guidelines. Due to the complexity, imaging centers usually face denials and erratic reimbursements when they use generalist billing groups.

If your practice is weighing the option of external assistance, I suggest taking a look at this industry-compiled shortlist of trusted billing partners for imaging services — it ranks vendors by experience, specialties, and audit defense ability.

Reference Links:

CMS NCCI Coding Edits

AAPC CPT® Code Search

Radiology Business – Compliance Updates

ACR Appropriateness Criteria®