CPT Codes for CT Chest
The CPT codes for CT chest imaging are: 71250 (without contrast), 71260 (with contrast), and 71270 (without and with contrast).
Standard CPT Code Structure
The American College of Radiology uses a standardized coding system for chest CT examinations based on contrast administration 1:
- CPT 71250: CT chest without IV contrast
- CPT 71260: CT chest with IV contrast
- CPT 71270: CT chest without and with IV contrast (biphasic study)
Clinical Context for Code Selection
When to Use CT Without Contrast (71250)
CT chest without IV contrast is appropriate for:
- Evaluation of interstitial lung disease and suspected chronic obstructive pulmonary disease 1
- Detection of pulmonary nodules and assessment of lung parenchyma 1
- Initial screening for tuberculosis when chest X-ray is equivocal (rated 7/9 "usually appropriate") 1
- Assessment of sternal fractures using sagittal and 3D reconstructions 2
- Evaluation of suspected renal calculus, retroperitoneal hematoma, or abdominal aortic aneurysm (when extended to abdomen/pelvis) 3
When to Use CT With Contrast (71260)
CT chest with IV contrast is the preferred modality for:
- Characterizing penetrating thoracic injuries, including vascular structures, heart, pericardium, and mediastinum (offers 99% negative predictive value) 1
- Diagnosing parapneumonic effusion or empyema (pleural enhancement acquired 60 seconds post-contrast optimizes pleural visualization) 1
- Evaluating suspected pulmonary hypertension (rated 7-8/9 "usually appropriate") 1
- Detecting vascular injuries such as pseudoaneurysms, intimal flaps, or contrast extravasation 1
When to Use CT Without and With Contrast (71270)
CT chest without and with IV contrast has limited indications:
- Generally rated 1-3/9 ("usually not appropriate") across most clinical scenarios 1
- No relevant literature supports routine use of biphasic chest CT for most thoracic pathology 1
- This protocol adds radiation exposure (☢☢☢) without significant diagnostic benefit in most cases 1
Important Technical Considerations
Contrast Timing Matters
- For pleural disease evaluation, acquire images 60 seconds after IV contrast bolus to optimize pleural enhancement 1
- CTA chest uses earlier contrast timing and may not allow sufficient time for pleural enhancement 1
Radiation Exposure
- All chest CT protocols carry ☢☢☢ radiation level (1-10 mSv effective dose) 1
- Biphasic studies (71270) effectively double radiation exposure without clear benefit 1
Common Pitfalls to Avoid
- Do not order CT without and with contrast (71270) routinely—this is rarely indicated and significantly increases radiation exposure 1
- Do not rely on non-contrast CT for vascular injury evaluation—contrast is essential for detecting pseudoaneurysms, active extravasation, and intimal tears 1, 4
- Do not use CTA timing protocols when evaluating pleural disease—standard contrast-enhanced CT with 60-second delay is superior 1
- Ensure adequate clinical history is provided—studies show 44.6% of non-contrast chest CTs are inappropriate when ordered without proper clinical indication 5