CPT Code 71260: CT Chest with Contrast

What is CT chest with contrast?

CPT code 71260 refers to a computed tomography (CT) chest scan with contrast material. This diagnostic imaging procedure is typically used to evaluate structures in the thorax, including the lungs of the patient, the heart, and the blood vessels. The contrast enhances visibility of soft tissues and vascular structures, helping physicians detect abnormalities such as tumors, infections, or blood clots.

Code 71260 is typically used when a non-contrast CT (e.g., CPT code 71250) cannot accurately diagnose. The contrast material—administered intravenously—improves imaging for better assessment of mediastinal masses, vascular conditions, and cardiac anatomy. If applicable, this CT scan may be performed in a facility or office setting, with billing divided between the technical and professional components.

Radiologists or qualified healthcare providers interpret the results as part of the service. When submitting a claim, follow Medicare administrative contractor (MAC) guidelines and ensure that medical necessity supports the use of contrast.

Documentation requirements

Proper documentation is essential when billing the 71260 CPT code for a CT chest with contrast. To support medical necessity and ensure compliance with MAC guidelines, include the following:

• Reason for the CT scan: Clearly document symptoms or conditions being evaluated (e.g., chest pain, abnormal chest X-ray, suspected pulmonary embolism).
• Anatomical focus: Specify the chest as the targeted area and whether the scan will also assess other parts, such as the abdomen or head.
• Use of contrast material: State that contrast material was used and why it was medically necessary for diagnostic imaging.
• Imaging technique: Describe the computed tomography (CT) method, including whether it was performed with a single-phase or multi-phase scan.
• Ordering physician’s details: Include the name and credentials of the physician who ordered the exam, along with their rationale.
• Radiologist interpretation: Provide the final professional component report detailing findings on blood vessels, heart, and lung fields.
• Procedure location: Identify whether the scan was performed in an office or facility setting for appropriate billing.
• Follow-up plan: If the scan is to be used in conjunction with other CPT codes, like 71250, mention any follow-up or additional imaging.
• Additional documentation: When multi-phase scanning (e.g., arterial and venous phases) is performed, additional documentation may be required to support the medical necessity and appropriate coding, as payer policies can vary regarding multi-phase CT scans

Billing guidelines

CPT code 71260 is billed when a computed tomography (CT) chest scan is performed with contrast material. This code includes both the technical and professional components unless modifiers TC or -26 indicate separate billing by the facility and radiologist.

• The code is typically used to evaluate blood vessels, the heart, and other thoracic structures for conditions requiring enhanced diagnostic imaging.
• Medicare administrative contractors require documentation of medical necessity, including the reason contrast was needed to better evaluate the tomography thorax.
• Do not report 71260 in conjunction with CPT codes 71250 (without contrast) for the same session, unless separately performed and documented.
• For accurate reimbursement, ensure the correct submission of the claim with supporting medical records and physician orders.
• If CT scans of other parts, such as the abdomen or head, are ordered, use the appropriate CPT codes and follow bundling guidelines.