CPT® 70496 - JF Part B
CPT® 70496; Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing
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® 70496; Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing. 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® 70496; Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing. The quarterly edit effectiveness results from October 1, 2025, through December 31, 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
- Failure to Return Records
- NCD 220.1
- MLN SE17023: Guidance on Coding and Billing Date of Service on Professional Claims
- Documentation and Coding that Demonstrates Medical Necessity
Education
Computed tomographic angiography (CTA) is a procedure used for the imaging of vessels to detect aneurysms, blood clots, and other vascular irregularities. A contrast medium is used to enhance imaging. CTA provides information unavailable with conventional angiography, such as vessel wall thickness and the venous anatomy of a target organ and/or associated organs within the scan range. These codes include contrast medium and non-contrast images, if performed. These codes report a global code supporting the technical and professional component. Append modifier 26 to report only the professional component or TC modifier to report only the technical component.
National Coverage Determination (NCD) 220.1 provides coverage criteria for computed tomography (CT). Per the NCD, documentation must clearly support the CT scan was medically necessary for the individual beneficiary taking into consideration their symptoms and potential diagnosis.
If the provider did not perform a global service and instead performed only one component, the date of service for the technical component would be the date the patient received the service and the date of service for the professional component would be the date the review and interpretation is completed.
