CPT® 71046: Radiologic examination, chest; 2 views - JF Part B
CPT® 71046: Radiologic examination, chest; 2 views
In order to fulfill its contractual obligation with CMS, Noridian Healthcare Solutions (Noridian), your Medicare Contractor, performs pre-payment reviews in accordance with CMS direction. CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. Medical review assesses submitted documentation to validate provider compliance with Medicare payment rules and regulations, including coverage, coding and billing guidelines.
This is to update providers of the claim review findings for CPT® 71046: Radiologic examination, chest; 2 views. The results of this focused review are not a reflection on providers' competence as a health care professional or the quality of care provided to patients. Specifically, the results are based on the documentation requested by Medicare and/or your facility's compliance with the required documentation.
The Jurisdiction F, Part B Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT® 71046: Radiologic examination, chest; 2 views. The quarterly edit effectiveness results from April 1, 2025, through June 30, 2025, are as follows:
Top Denial Reasons
- Denial Reason 1 - Failure to return records
- Denial Reason 2 - The documentation submitted was incomplete and/or insufficient
- Denial Reason 3 - The documentation submitted does not support medical necessity as listed in coverage requirements in the National Coverage Determination or Local Coverage Determination
Educational Resources
Education
Noridian has a Local Coverage Determinations (LCD) policy that pertains to Chest X-Rays. Please visit our website www.noridianmedicare.com to view the LCD JF L37549 - Chest X-Ray Policy for full coverage guidance.
The LCD also lists diagnosis that are not reasonable and necessary based on literature from medical societies and clear community standards and for which the data analysis shows are the more common reasons for denial.
A chest X-ray that is not reasonable and necessary contributes to unneeded patient radiation exposure, patient anxiety, unnecessary visits to a medical or radiology facility, and increased costs to both patients and the Medicare Trust Fund.
In general, preprocedural chest X-rays in the absence of symptomatic pulmonary or cardiac disease(s), chest X-rays in the absence of signs or symptoms, and chest X-rays for minor trauma of the head, lower back or extremities are not reasonable and necessary. If a patient with known but stable, asymptomatic cardiac or pulmonary disease requires a chest X-ray, the reason(s) for the chest radiograph(s) must be clearly documented in the clinical chart with an explanation of how the results of the X-ray will be used for the patient’s care
If a patient with known but stable, asymptomatic cardiac or pulmonary disease requires a pre-procedural chest X-ray, the reason(s) must be documented in the clinical chart with an explanation of how the results of the X-ray would be used for the patient’s care. Patients with symptomatic cardiac or pulmonary conditions (e.g., adverse change in cough, orthopnea, dyspnea on exertion, recent decrement in SaO2), planning surgery performed in ASC or outpatient facilities, the chart must document how the x-ray results will be used to make treatment decisions.
Radiographs of the chest are commonly performed in outpatient offices (radiology and many others), clinics, outpatient hospital departments, inpatient hospital episodes, skilled nursing facilities, homes, and other settings. They are used to diagnose and aid in treatment decisions for pulmonary diseases, cardiac diseases, infections and inflammatory diseases, chest and upper abdominal trauma situations, malignant and metastatic diseases, allergic and drug related diseases.
In general, preprocedural chest X-rays in the absence of pulmonary or cardiac diseases, chest X-rays in the absence of signs or symptoms, and chest X-rays for minor trauma of the head, lower back or extremities are not the current accepted medical practice.
