Quick Answer
CPT 70472 is a 2026 add-on code for CT cerebral perfusion analysis with contrast, including image postprocessing, performed with a concurrent CT or CTA of the same anatomy. You bill it with 70450, 70460, 70470, 70471, or 70496. CPT 70473 reports the same analysis without a concurrent CT or CTA. Both replaced 0042T on January 1, 2026.
Key Takeaways
- Code description: The 70472 CPT code is an add-on with a ZZZ global period. You can’t bill it without a qualifying head CT or CTA primary.
- Replaced code: The AMA deleted 0042T on January 1, 2026. Keep it for dates of service before that day.
- KX modifier: Noridian (JE, JF) and CGS (J15) require KX to attest a certified stroke center. It isn’t a nationwide Medicare rule.
- Payment: Medicare’s 2026 national rate for 70472 is $156.32 global and $36.41 with modifier 26, before geographic adjustment.
- Prior authorization: UnitedHealthcare commercial plans added 70472 and 70473 on April 1, 2026. ER, urgent care, observation, and inpatient settings are exempt.
- Documentation: The report must show the perfusion analysis, any concurrent CT or CTA, the indication, and retained reconstruction data.
What Is CPT Code 70472?
CPT 70472 is a Category I add-on code for CT cerebral perfusion analysis performed in the same session as a CT or CTA of the head. The CPT book marks it with a plus sign. You report it with one of five primaries: 70450, 70460, 70470, 70471, or 70496. Its ZZZ global period follows that primary.
CT perfusion (CTP) tracks a contrast bolus through brain tissue to map cerebral blood flow, cerebral blood volume, and mean transit time. Stroke teams read those maps to separate the infarct core from the salvageable penumbra before deciding on thrombectomy. In the chart, you’ll see it called a cerebral perfusion study.
The 70472 Descriptor in Plain English
The AMA’s CPT 2026 descriptor reads: “Computed tomographic (CT) cerebral perfusion analysis with contrast material(s), including image postprocessing, performed with concurrent CT or CT angiography of the same anatomy (List separately in addition to code for primary procedure).” Three phrases in that descriptor drive your coding:
- With contrast material(s): IV contrast is part of the service.
- Including image postprocessing: The perfusion maps sit inside the code, so you don’t add a 3D rendering line.
- Concurrent CT or CTA of the same anatomy: The head study and the perfusion run happen in one session.
“Same anatomy” means the brain, so a neck-only CTA (70498) can’t anchor the add-on. If the CTA covers the head and neck together, the primary is 70471, and our CTA head and neck billing guide covers that claim in full.
CPT 70472 at a Glance (2026)
| Field | Detail |
|---|---|
| Code type | Category I add-on (+70472) |
| Effective date | January 1, 2026 |
| Replaces | 0042T (deleted January 1, 2026) |
| Report with | 70450, 70460, 70470, 70471, or 70496 |
| Can’t report with | 70473, 76376, or 76377 |
| Global period | ZZZ (follows the primary procedure) |
| 2026 Medicare national rate (non-QP conversion factor $33.4009) | $156.32 global, $36.41 (26), $119.91 (TC), before geographic adjustment |
| KX modifier | Required by Noridian (JE, JF) and CGS (J15); MAC-specific |
| Commercial prior authorization | UnitedHealthcare commercial, Community Plan, Individual Exchange, Oxford, and Rocky Mountain Health Plans from April 1, 2026 |
What Replaced CPT 0042T?
Two Category I codes, 70472 and 70473, replaced Category III code 0042T on January 1, 2026. For years, that temporary code covered cerebral perfusion analysis on the emerging technology track. The AMA split it into two codes based on one question: did a CT or CTA run in the same session?
If you’re searching the 0042T CPT code description for a 2026 claim, you’re looking at a deleted code. Bill 0042T for dates of service before January 1, 2026, including older AR still in follow-up, and 70472 or 70473 for dates on or after it.
Both codes sit among the radiology CPT codes 2026 introduced for head imaging. That release brought 288 new codes, 84 deletions, and 46 revisions, according to the AMA’s CPT 2026 code set release.
70472 vs 70473: Which CT Perfusion Code Do You Bill?
Bill +70472 if perfusion runs with a same-session CT or CTA of the head, and bill 70473 if it runs without one. The choice on the 70472 CPT add-on comes down to a single test: did a CT or CTA of the same anatomy happen in that session? Order count and the ordering physician don’t change the answer.
When CPT Code 70473 Is the Right Code
CPT 70473 is a standalone code for CT cerebral perfusion analysis with contrast when no CT or CTA of the same anatomy runs in that session. You bill it by itself, with no plus sign and no primary procedure attached.
70473 can’t go on the same claim as 70450, 70460, 70470, 70471, 70472, 70496, 76376, or 76377 for that session. If a head CT or CTA ran alongside the perfusion, the study belongs on +70472 with its primary.
The Transfer Patient Scenario
A patient gets a noncontrast CT and a CTA at a community hospital, then transfers to a certified stroke center that runs the perfusion analysis on its own. The receiving center bills CPT 70473, because no CT or CTA ran in its own session.
Under CGS (J15) and Noridian (JE, JF), that 70473 claim also carries the KX modifier. The CGS billing article A58218 names this transfer case in its instructions. Leave KX off, and the remittance comes back with a modifier denial.
Meanwhile, the sending hospital bills its own CT and CTA, so the two facilities’ claims can’t overlap. Keeping sending and receiving claims apart is routine work for hospital revenue cycle management teams, and transfer cases are where that work slips.
70472 vs 70473 Decision Table
| Scenario | Same-session CT or CTA of the head? | Bill | KX (Noridian, CGS) |
|---|---|---|---|
| ED stroke alert: noncontrast CT, CTA head and neck, perfusion | Yes | 70471 + 70472 (no separate 70450) | Yes, on 70472 |
| Noncontrast head CT plus perfusion | Yes | 70450 + 70472 | Yes, on 70472 |
| CTA head only plus perfusion | Yes | 70496 + 70472 | Yes, on 70472 |
| Perfusion only, no CT or CTA that session | No | 70473 | Yes, on 70473 |
| Transfer: CT and CTA at an outside hospital, perfusion at the stroke center | No (at the receiving facility) | 70473 | Yes, on 70473 |
| CTA neck only (70498) plus perfusion | Neck isn’t the same anatomy | 70498 can’t anchor +70472; confirm code selection with CPT guidance before billing | Check your MAC |
Is 70473 a CT Angiography Code?
No. 70473 reports perfusion analysis of brain tissue, and angiography sits under the CTA codes. A CTA shows the vessels and where a clot blocks them. Perfusion measures how blood moves through the tissue those vessels feed. Some search answers frame 70473 as angiography, and coders who follow that framing pair the wrong codes.
Which Primary Codes Can You Report With +70472?
You can report CPT 70472 with five primary codes from the same session: 70450, 70460, 70470, 70471, and 70496. Each one images the head. If the claim carries no qualifying primary, the payer rejects the add-on line, and the remittance points you back to the missing code.
The Five Qualifying Primary Codes
| Primary code | What it describes | Qualifies for +70472? |
|---|---|---|
| 70450 | CT head or brain without contrast | Yes |
| 70460 | CT head or brain with contrast | Yes |
| 70470 | CT head or brain without contrast, then with contrast | Yes |
| 70471 | CTA head and neck (new for 2026) | Yes |
| 70496 | CTA head only | Yes |
| 70498 | CTA neck only | No |
| 70490 to 70492 | CT soft tissue neck | No |
Why 70498 Can’t Anchor the Add-On
Perfusion images the brain. 70498 covers the neck vessels alone, so it fails the “same anatomy” test in the descriptor. If a stroke protocol includes a CTA of the head and neck in one session, report 70471 as the primary.
Some AI search answers and code lookup sites describe the primary as a “head or neck CTA.” That wording suggests 70498 qualifies, and it doesn’t. Pair 70498 with +70472 and you’ve built a denial.
Codes You Can’t Report With 70472 or 70473
CPT parenthetical notes block three combinations outright, and AAPC’s CPT 2026 summary lists the same 70473 exclusions. Load them into your scrubber as hard stops, because a missed pair means a corrected claim and a second wait for payment.
| Combination | Allowed? | Why |
|---|---|---|
| 70472 + 70473 | No | A study can’t be concurrent and non-concurrent at once |
| 70473 + 70450, 70460, 70470, 70471, or 70496 | No | A same-session CT or CTA means +70472 applies |
| 70472 or 70473 + 76376 or 76377 | No | Postprocessing is part of the perfusion code |
These CPT rules apply whether or not a payer’s edit catches them. NCCI procedure-to-procedure edits are a separate control, and CMS updates them each quarter. Check the current NCCI PTP edit files (version 32.3, effective October 1, 2026) before you assume a pair will or won’t stop.
Stroke Protocol Claims: One Session, One Primary
Picture a typical ED stroke alert. The team runs a noncontrast head CT to rule out hemorrhage, then a CTA of the head and neck, then perfusion, all on the same table. Three orders sit in the chart. Your claim is 70471 plus +70472, and 70450 stays off because 70471 includes the noncontrast images.
Build your charge rule around the imaging session. Three orders tempt three charges, and that’s how this claim goes out wrong. If the head CT is the lone study that session, our CT head without contrast billing guide walks through that claim.
If stroke protocol claims keep going out with an extra line, our radiology medical billing team builds session rules into charge entry, so the claim is right before it drops.
Medicare Coverage for 70472 and 70473: KX Modifier, LCDs, and ICD-10 Codes
Your Medicare Administrative Contractor (MAC) sets coverage for CPT code 70472, and the rules differ by jurisdiction. CMS has no National Coverage Determination for CT perfusion, so you won’t find one national rule to follow.
A few MACs publish a Local Coverage Determination (LCD) with a billing and coding article. Those articles set the KX rule, the covered diagnoses, and the documentation standard, and they hold the Medicare guidelines for 70473 too. Other MACs have none. Our guide on how LCDs and billing articles work together explains the link between the two documents.
KX Modifier Requirements by MAC
KX on perfusion claims is MAC-specific, and it isn’t a nationwide Medicare rule. Noridian Healthcare Solutions (JE, JF) and CGS Administrators (J15) require it on both codes. The table below reflects the Noridian billing article A58223 (updated March 18, 2026) and CGS article A58218.
| MAC (jurisdiction) | States | Billing article | KX on 70472 | KX on 70473 | ICD-10 codes listed |
|---|---|---|---|---|---|
| Noridian (JE, JF) | CA, NV, HI, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, and Pacific territories | A58223 (revision effective January 1, 2026; updated March 18, 2026) | Yes | Yes | 47 |
| CGS (J15) | KY, OH | A58218 | Yes | Yes | 46 |
| National Government Services (J6, JK) | IL, MN, WI, NY, and New England | A58152 (current revision not confirmed) | Not found in the version reviewed | Not found in the version reviewed | Confirm in the MCD |
| Other MACs | Remaining states | No CT perfusion billing article found as of October 2026 | Check the MCD | Check the MCD | Not applicable |
The KX modifier for CT perfusion attests that a certified stroke center performed the study. If you bill outside Noridian and CGS territory, don’t append KX out of habit. Search the Medicare Coverage Database by code and state, and use the article version in effect on the date of service. CPT code 70473 follows the same check.
The ER Rule and Certified Stroke Centers
Under Noridian and CGS, a perfusion study in the emergency room (POS 23) qualifies when that ER is part of the certified stroke center. If your freestanding ED partners with a stroke center but sits outside its certification, the KX attestation doesn’t fit that claim.
Neither article names a required certification level. The Joint Commission certifies four: Comprehensive, Thrombectomy-Capable, Primary, and Acute Stroke Ready. Keep your certification records where an auditor can reach them, and see the Joint Commission stroke certification levels for definitions.
ICD-10 Codes That Support CT Perfusion
Noridian’s list in A58223 holds 47 codes. Scan the groups below by condition to find the documented diagnosis, and keep in mind that the list applies in Noridian territory.
| Group | Codes on Noridian’s list |
|---|---|
| Acute ischemic stroke, carotid and MCA | I63.031, I63.032, I63.131, I63.132, I63.231, I63.232, I63.311, I63.312, I63.411, I63.412, I63.511, I63.512 |
| Vascular syndromes | G45.1, G46.0 |
| Speech and neurologic deficits | R47.01, R47.02, R47.1, R47.81, R29.810, R41.4, R26.0 |
| Sudden vision loss | H53.131, H53.132, H53.133 |
| Hemiplegia | G81.01 to G81.04, G81.91 to G81.94 |
| Stroke sequelae | I69.320 to I69.323, I69.344, I69.351 to I69.354, I69.992 |
| Hemiplegic migraine and thunderclap headache | G43.401, G43.409, G43.411, G43.419, G44.53 |
Two codes billers reach for first aren’t on the list: I63.9 (cerebral infarction, unspecified) and G45.9 (transient cerebral ischemic attack, unspecified). Code to the documented vessel and side. CGS’s list matches Noridian’s except R29.810, which Noridian added in revision R6.
National Government Services’ article, in the version we reviewed, adds codes such as G83.84, H53.8, H53.9, R26.2, R27.8, R27.9, R47.89, and R47.9. 70472 medical necessity rests on your own contractor’s current list, so verify it before you build scrubber edits.
Why Medicare Billing Articles Mention “CCTA”
Noridian’s current article describes 70472 as perfusion performed “at the same time as CCTA” and spells CCTA out as Coronary CT Angiography. Its 70473 paragraph also references AI-QTC, an “Artificial Intelligence QT interval Corrected Analysis.” The wording appears to carry over cardiac language.
The CPT descriptor controls code selection: concurrent CT or CTA of the same anatomy, meaning the head. A coronary CTA doesn’t qualify as a primary for +70472, and our page on coronary CTA billing under CPT 75574 covers that study. If a reviewer leans on that wording, appeal with the CPT descriptor and the head CT or CTA report.
The same paragraph asks for documentation of the earlier angiography study before 70473 pays. On a transfer patient, that means the sending hospital’s CT or CTA report belongs in your record.
What the Report and Record Must Show
Noridian’s article sets the documentation standard. Before the claim drops, confirm your record holds:
- A formal written report with patient demographics, the interpreting provider, and the reason for the test
- A statement that perfusion analysis ran, and whether a concurrent CT or CTA ran with it
- Copies of the images, with the computerized reconstruction data kept on file
- The ordering provider’s assessment, relevant history, and pertinent results
- The referring or ordering provider’s name and NPI on the claim
The MAC returns a cerebral perfusion study claim without a valid ICD-10-CM code as incomplete, before anyone looks at medical necessity. Check the diagnosis field at charge entry, since a blank or truncated code stops the claim at the front end.
KX rules, diagnosis lists, and article versions all shift by MAC. If you bill across jurisdictions, an imaging claims audit shows where perfusion claims are leaking before the next revision lands.
How Much Does Medicare Pay for CPT 70472 in 2026?
Medicare’s 2026 national payment for +70472 is $156.32 global and $36.41 for the professional component, before geographic adjustment. Those figures use the non-QP conversion factor of $33.4009. Your 70472 reimbursement moves up or down from there with your locality’s geographic practice cost index (GPCI).
2026 Medicare Payment for 70472 and 70473
| Code | Component | 2026 national rate, non-QP ($33.4009), before geographic adjustment |
|---|---|---|
| +70472 | Global | $156.32 |
| +70472 | Professional (modifier 26) | $36.41 |
| +70472 | Technical (TC) | $119.91 |
| 70473 | Global | $241.15 |
| 70473 | Professional (modifier 26) | $47.43 |
Qualifying participants (QPs) in an Advanced Alternative Payment Model get the higher $33.5675 conversion factor, which puts +70472 at $157.10 global and CPT 70473 at $242.36 global, before geographic adjustment. Unless your group holds QP status for 2026, model your payments on the non-QP figures.
For the 70473 technical component, pull the rate for your locality from the CMS PFS Look-Up Tool instead of subtracting one figure from another. Medicare Part B patients owe 20% coinsurance after the annual deductible, so your patient statements carry part of each rate.
Who Bills the Professional and Technical Components
An imaging center that owns the scanner and employs the radiologist sends one global claim with no modifier. Hospital-based radiology groups bill modifier 26 alone, and the hospital’s facility payment comes through the outpatient system instead of the $119.91 TC figure.
Some AI search answers present $156.32 as both the facility and non-facility rate. That mixes two payment systems: the physician fee schedule pays the radiologist, and OPPS pays the hospital. Our guide to modifier 26 split billing covers the component rules in depth.
Hospital Outpatient Payment (OPPS)
Hospital payment for 70472 and 70473 follows OPPS status indicators and APC assignments, separate from the physician fee schedule. Confirm both codes in the current CMS OPPS Addendum B before you set expected payment in your contract model.
How RVUs Turn Into Payment
Medicare multiplies the total RVU by the conversion factor. For +70472, the work RVU of 0.77, practice expense RVU of 3.85, and malpractice RVU of 0.06 add up to 4.68, and 4.68 × $33.4009 = $156.32. 70473 carries 7.22 total RVUs, with a work RVU of 1.09.
Radiology groups use that same RVU per CPT code math for productivity. In relative value units, radiology reads of +70472 earn 0.77 work RVUs each. If your productivity reports pull the RVU for CPT codes from an older file, update them with the 2026 values.
The 2026 values come from the CY 2026 Physician Fee Schedule final rule, which valued 70472, 70473, and 70471 together. If you’re looking for an RVU calculator radiology teams can trust, the CMS PFS Look-Up Tool does that job with official numbers for your locality.
Commercial Payer Coverage and Prior Authorization for 70472 and 70473
Commercial coverage for CPT 70472 depends on each payer’s own policy, and some plans now require prior authorization for scheduled outpatient studies. Payers revise these policies on their own schedules, so treat the matrix below as a starting point and verify before scheduling.
Payer Coverage Matrix
Aetna CPB 0663, reviewed October 14, 2026, lists 70472 and 70473 as covered when its criteria are met. The other rows come from each payer’s published policy or notice.
| Payer (verify before scheduling) | Prior authorization | Covered uses | Not covered or investigational |
|---|---|---|---|
| Traditional Medicare | No program found for these codes | Set by your MAC (see the Medicare section) | Varies by MAC |
| UnitedHealthcare commercial, Community Plan, Individual Exchange, Oxford, Rocky Mountain Health Plans | Yes, from April 1, 2026 | Per UnitedHealthcare radiology policy | Per policy |
| UnitedHealthcare Medicare Advantage and D-SNP | Not part of the April 2026 change | Per plan | Per plan |
| Aetna (CPB 0663, reviewed October 14, 2026) | Check the plan | Acute stroke under 24 hours (including hemorrhagic stroke and subdural hemorrhage), TIA, follow-up of acute ischemia, occlusive disease, cerebral hyperperfusion syndrome, solid tumor vascular status when MRI is degraded, tumor response to therapy, moyamoya | Brain death, vasospasm after aneurysmal SAH, gliomas, head trauma and TBI, HSV encephalitis, cognitive impairment prognosis, balloon occlusion test, and other listed uses |
| BCBS Mississippi | Check the plan | Selecting patients with anterior circulation large-vessel stroke for mechanical thrombectomy | All other uses |
| Other BCBS plans and state Medicaid | Varies | Check the plan’s current policy | Check the plan’s current policy |
BCBS plans are independent licensees, so a Mississippi rule tells you nothing about Texas or New York. In Mississippi, BCBS Mississippi’s perfusion policy limits coverage to thrombectomy selection. Check the member’s own plan policy when you schedule, before the claim ever goes out.
UnitedHealthcare’s April 2026 Prior Authorization Change
UnitedHealthcare added 70472 and 70473 to its outpatient radiology prior authorization program on April 1, 2026. UnitedHealthcare’s December 2025 notice, dated December 12, cited the AMA’s coding changes. The change covers commercial, Community Plan, Individual Exchange, Oxford, and Rocky Mountain Health Plans members, and it leaves out Medicare Advantage and D-SNP plans.
Four settings are exempt: emergency room, urgent care, observation, and inpatient stay. An ED stroke alert needs no authorization. A scheduled outpatient perfusion study, such as moyamoya follow-up, needs one. Build your scheduling rule around setting, because 70472 prior authorization turns on where the study runs.
Setting-based exemptions are easy to miss at the front desk. Our prior authorization services team checks the code, plan, and setting before the patient is on the table.
Where Payer Coverage Rules Split
Aetna’s covered diagnosis list includes I63.9, R42 (dizziness), and R51.9 (headache, unspecified). Noridian’s Medicare list includes none of the three. A perfusion claim that pays under Aetna can deny under Medicare with the same diagnosis, so map diagnosis rules by payer.
Aetna also covers perfusion for acute hemorrhagic stroke and subdural hemorrhage, yet it treats head trauma and TBI as investigational. A subdural that follows a fall sits close to that investigational line, so code the documented cause of the bleed with care.
Why 70472 Claims Deny and How to Fix Them
Most denials on the 70472 CPT code trace to five causes: a missing KX modifier, a missing primary code, a bundling conflict, an unsupported diagnosis, or missing authorization. Each one leaves a recognizable reason code on the remittance, and each has a prevention step that belongs upstream of the coder.
Denial Codes, Causes, and Fixes
| CARC (common RARC) | What triggered it | Fix | Prevention |
|---|---|---|---|
| CO-4 (remark codes vary by MAC) | KX missing under Noridian or CGS | Add KX, then resubmit as a corrected claim | MAC-based modifier rule in the scrubber |
| B15 (N122) | +70472 billed with no qualifying primary on the claim | Add the primary (70450, 70460, 70470, 70471, or 70496), or rebill as 70473 if no CT or CTA ran | Add-on to primary pairing edit |
| CO-236 or CO-97 | 70473 billed with a same-session CT or CTA, or a perfusion code billed with 76376 or 76377 | Recode to 70472, or remove the 3D line | Session-based charge rule |
| CO-50 (N115) | Diagnosis isn’t on the MAC’s covered list | Correct the diagnosis if the record supports it, or appeal with the record | Diagnosis check by MAC before submission |
| CO-197 | No authorization on an outpatient UnitedHealthcare commercial study | Request retro-authorization where the plan allows it, then appeal | Authorization check by setting at scheduling |
| CO-16 (N265) | Ordering provider NPI missing or invalid | Add the ordering NPI, then resubmit | Required-field edit |
| CO-181 or clearinghouse rejection | 0042T billed for a 2026 date of service | Rebill as 70472 or 70473 | Charge master cleanup |
Payers vary, so act on the CARC printed on your remittance when you work a 70472 denial. Our guides on CO-4 modifier denials and CO-236 NCCI edit denials cover the modifier and bundling rows in depth.
For diagnosis, authorization, and NPI problems, see our breakdowns of CO-50 medical necessity denials, CO-197 authorization denials, and CO-16 missing information denials. Those pages walk through the remark codes and the resubmission path for each.
Trace Each Denial to Its Workflow Source
If the same CARC shows up three times in a month for one payer, look at the workflow before you look at the coder. Map each denial to the step that produced it:
- Scheduling, for authorization gaps
- Charge capture, for session rules
- The scrubber, for KX and add-on edits
- Documentation, for diagnosis support
Use a corrected claim (frequency code 7) for modifier and data errors, and save appeals for disputes over the payer’s decision. A corrected claim fixes your own data. Picking the wrong route adds weeks to the timeline.
If perfusion denials keep coming back under the same CARC, our denial management team traces them to the workflow step causing them.
0042T to 70472: Transition Rules and Charge Master Cleanup
Report 0042T for dates of service through December 31, 2025, and report 70472 or 70473 for dates of service from January 1, 2026, onward. The date of service picks the code. A December 2025 study billed in February 2026 still goes out under the old Category III code.
Searching for the CPT code 0042T now matters for claims still in appeal or sitting in AR. Keep the 0042T CPT code billable for those older dates of service in your billing system, so late claims still go out on the right code.
Six-Step Charge Master Cleanup Checklist
- End-date 0042T in the charge master at December 31, 2025, and add 70472 and 70473 with the correct revenue codes.
- Re-map scanner and RIS protocol names that still fire the deleted code.
- Rebuild stroke-protocol order sets around the imaging session.
- Confirm each commercial payer has loaded 70472 and 70473 into its fee schedule, since contracts that priced the old code need a rate for the new codes.
- Skip any separate charge for AI perfusion software, because the analysis and postprocessing sit inside 70472 and 70473.
- Track perfusion claims by CARC for 90 days after go-live, and fix each pattern at its source.
These were among the radiology CPT codes 2026 introduced that hit the charge master on day one. 70471 needs the same treatment, since it now covers a same-session CTA of the head and neck that used to go out as two codes.
What Other Sources Get Wrong About CT Perfusion Coding
Some popular sources, including AI search answers, carry errors about 70472 and 70473 that lead to denials. The table pairs each claim you may read with what CPT, CMS, and the MAC articles support.
| What you may read | What’s correct |
|---|---|
| The KX modifier is required on every Medicare perfusion claim | Noridian (JE, JF) and CGS (J15) require KX, and it isn’t a national rule. |
| Any “head or neck CTA” can anchor +70472 | 70498 (CTA neck only) doesn’t qualify; the primary must be 70450, 70460, 70470, 70471, or 70496. |
| 70496 and 70498 were deleted in 2026 | Both remain valid for single-region CTA, and a same-session CTA of the head and neck moves to 70471. |
| 70496 covers the head and neck | 70496 is CTA head only. |
| Use RT or LT on perfusion codes | We found no CPT, CMS, or MAC guidance calling for laterality modifiers on 70472 or 70473. |
| $156.32 is both the facility and non-facility rate | That’s the physician fee schedule global rate, and OPPS pays hospitals. |
| Status indicator A means the hospital is paid separately | That indicator comes from the physician fee schedule, not OPPS. |
| “CCTA” in MAC articles means a coronary study qualifies | The CPT descriptor requires a CT or CTA of the same anatomy, which is the head. |
| 70473 is a CT angiography code | 70473 reports perfusion analysis of brain tissue. |
Frequently Asked Questions About CPT 70472 and 70473
What is CPT 70472?
70472 is an add-on code for CT cerebral perfusion analysis with contrast, performed in the same session as a CT or CTA of the head. You report it with 70450, 70460, 70470, 70471, or 70496. Its descriptor includes image postprocessing, so you don’t bill 3D rendering on top.
What does CPT code 70473 mean?
70473 means CT cerebral perfusion analysis with contrast, performed without a concurrent CT or CTA of the same anatomy. It’s a standalone code. The common case is a transfer patient whose CT and CTA ran at the sending hospital, with perfusion done at the receiving stroke center.
What is the difference between 70472 and 70473?
70472 and 70473 differ on one point: concurrency. Bill +70472 when a CT or CTA of the head runs in the same session, and 70473 when perfusion runs alone. Neither one is a CT angiography code. Both report perfusion analysis of brain tissue, with contrast and postprocessing included.
How much does Medicare pay for CPT 70472?
+70472 pays $156.32 global and $36.41 with modifier 26 under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. The technical component pays $119.91. Your locality’s GPCI changes the final amount, and hospitals receive their facility payment through OPPS.
Is 70472 an add-on code?
Yes. 70472 is an add-on code, marked with a plus sign in CPT, with a ZZZ global period. You can’t bill it alone. A claim without a qualifying primary (70450, 70460, 70470, 70471, or 70496) rejects, and the remittance shows a code such as B15 with remark N122.
What replaced 0042T?
70472 and 70473 replaced 0042T on January 1, 2026. The date of service controls the choice. Studies performed before that date still go out under the old code, even if you submit the claim in 2026. For dates on or after it, bill 70472 or 70473, based on whether a CT or CTA ran that session.
Does every Medicare claim for 70472 need the KX modifier?
No. KX is a MAC-specific rule. Noridian (JE, JF) and CGS (J15) require KX on 70472 and 70473 to attest that a certified stroke center performed the study. We found no KX requirement from other MACs as of October 2026, so check your contractor’s current billing article.
What does CTP stand for in medical billing?
CTP stands for CT perfusion, an imaging study that tracks contrast through brain tissue to measure cerebral blood flow, cerebral blood volume, and mean transit time. In 2026 coding, you report a brain perfusion study with +70472 when it pairs with a same-session head CT or CTA, and with 70473 when it doesn’t.
What is the effective date for 70472?
70472 took effect January 1, 2026, as part of the AMA’s CPT 2026 code set. Medicare accepts it for dates of service on or after that date. Confirm that each commercial payer has loaded it into your contract fee schedule, because a missing rate can hold up payment.
Does 70472 need prior authorization?
Yes, under some commercial plans. UnitedHealthcare added 70472 and 70473 to its outpatient radiology program on April 1, 2026, with emergency room, urgent care, observation, and inpatient settings exempt. We found no prior authorization program for these codes in traditional Medicare.
Who bills 70472, radiology or neurology?
70472 belongs to the physician who interprets and reports the perfusion analysis, since CPT doesn’t limit it to one specialty. Hospital-based radiology groups bill it with modifier 26 in most settings. The facility bills its side under OPPS, and an imaging center that owns the scanner bills the global service.
Getting CT Perfusion Claims Paid the First Time
Three questions settle a CPT 70472 claim, and your team can answer each one before the claim drops:
- Did a CT or CTA of the head run in the same session?
- Do your MAC’s or payer’s rules call for KX, prior authorization, or a specific diagnosis?
- Does the record show the perfusion analysis and the indication?
None of this is exotic coding. Claims slip when no one on your team owns the path from scheduling to remittance, and perfusion claims touch more of that path than most imaging lines.
That ownership is what One O Seven RCM provides for imaging groups and hospitals: session-based charge rules, MAC-specific modifier edits, and prior authorization checks before the scan. A review of your recent perfusion claims is an easy place to start.
Sources
- American Medical Association: AMA releases CPT 2026 code set
- AAPC: CPT 2026, the wait is over
- CMS Medicare Coverage Database: Billing and Coding Article A58223 (Noridian)
- CMS Medicare Coverage Database: Billing and Coding Article A58218 (CGS)
- The Joint Commission: Advanced Stroke Certification
- Federal Register: CY 2026 Physician Fee Schedule final rule
- CMS: Physician Fee Schedule Look-Up Tool
- CMS: Medicare NCCI Procedure to Procedure (PTP) Edits
- UnitedHealthcare: Codes added to radiology and cardiology prior authorization
- Aetna: Clinical Policy Bulletin 0663
- Blue Cross and Blue Shield of Mississippi: CT Perfusion Imaging of the Brain
