What documentation does 70450 require?

- Order with clinical indication. "Acute neurologic deficit," "head trauma with LOC," "sudden severe headache," "altered mental status," "suspected stroke" are all valid medical-necessity justifications. - Interpretation report includes: ventricular system, basal cisterns, midline structures, gray-white differentiation, presence or absence of intra-axial/extra-axial hemorrhage, mass effect, herniation, bony skull/calvarium, comparison with prior imaging. - Radiologist signature and report date. - If contrast is administered for a CT angiogram or perfusion add-on, those are separate codes (70496 CTA head, 0042T perfusion).

What are common 70450 billing pitfalls?

- Billing 70450 plus 70460 plus 70470 on the same study. The without-and-with code (70470) replaces the two separate codes when both phases are performed. - Order without indication. "Head CT" alone is denied; add a symptom or finding. - Confusing CT head with CT facial bones (70486) or CT sinuses (70486) — those are distinct codes for different anatomy.

How much does 70450 pay in 2026?

2026 work RVU for 70450 is 0.85. National Medicare non-facility allowable is approximately $102.54 at the 2026 conversion factor. Adjust for locality GPCI and your payer's contracted conversion factor for actual payment.

70450

RadiologyCMS status: A

Computed tomography of the head or brain without contrast material. CMS 2026 global wRVU 0.85, total RVU approximately 3.07, Medicare global allowable approximately $103. The workhorse ED and outpatient neuroimaging study. Modifier 26 for hospital interpretation; TC for imaging center facility-only billing.

Radiology Neurology Hospitalist Outpatient IM

Work RVU

0.85

Practice RVU

2.16

Malpractice RVU

0.06

Total RVU

3.07

2026 Medicare payment

$102.54

National GPCI = 1.000 · Conversion factor $33.4009 · Non-facility

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When to use it

70450 is the first-line head CT for acute neurological complaints when MRI is unavailable or contraindicated. Common indications: suspected acute stroke (rule out hemorrhage before tPA), head trauma, sudden severe headache (rule out SAH), altered mental status, suspected hydrocephalus, post-fall in anticoagulated patient. 70460 (with contrast) and 70470 (without and with) are reserved for mass evaluation, infection, or known intracranial pathology requiring contrast characterization. Do not bill all three (70450, 70460, 70470) on the same date for the same patient.

Documentation checklist

✓Order with clinical indication. "Acute neurologic deficit," "head trauma with LOC," "sudden severe headache," "altered mental status," "suspected stroke" are all valid medical-necessity justifications.
✓Interpretation report includes: ventricular system, basal cisterns, midline structures, gray-white differentiation, presence or absence of intra-axial/extra-axial hemorrhage, mass effect, herniation, bony skull/calvarium, comparison with prior imaging.
✓Radiologist signature and report date.
✓If contrast is administered for a CT angiogram or perfusion add-on, those are separate codes (70496 CTA head, 0042T perfusion).
✓Setting modifier as for all radiology services.

Common pitfalls

!Billing 70450 plus 70460 plus 70470 on the same study. The without-and-with code (70470) replaces the two separate codes when both phases are performed.
!Order without indication. "Head CT" alone is denied; add a symptom or finding.
!Confusing CT head with CT facial bones (70486) or CT sinuses (70486) — those are distinct codes for different anatomy.
!Billing 70450 plus 70496 (CTA head) on the same encounter without separating clinical questions. The CTA is a separately billable vascular study but requires its own indication (TIA, stroke, aneurysm screening, neck pain after trauma).
!Mistaking 70450 (head CT no contrast) for 70487 / 70488 (CT temporal bone) when the order is for hearing loss or vertigo work-up.

Common modifiers

26TC

Common ICD-10 pairings

I63.9S06.0X0AR51.9R41.82I60.9G93.6

Payer notes

Medicare covers 70450 with a documented neurologic indication. Medicare Advantage plans commonly require prior authorization for outpatient head CT; ED CT is typically auto-approved post-care. Commercial payers vary — Aetna, UnitedHealthcare, and Anthem require pre-authorization for outpatient head CT except in emergency or post-trauma settings. Patients with prior intracranial pathology, anticoagulation, or shunt may have lower auth barriers.