CPT® Code 71045

Quick Reference

• Code definition: CPT 71045 reports a single-view radiologic examination of the chest, capturing images of the heart, lungs, bronchi, major vessels, and thoracic bones using X-ray technology.
• Key billing rule: View count determines code selection. Report 71045 only when exactly one view is documented in the signed radiology report; the finalized report controls which code applies, not the order.
• Modifier essentials: PC/TC Indicator 1 governs this code. Bill modifier 26 when the interpreting physician does not own the imaging equipment; bill modifier TC when the facility reports equipment and staff costs without in-house interpretation. For serial same-day studies, modifier 76 (same physician) or 77 (different physician) identifies each repeat.
• Documentation must-have: A signed final radiology report explicitly stating the number and type(s) of views obtained. Technician notes alone do not satisfy Medicare Part B payment requirements.
• Top confusion point: Billing 71046 when only one view was obtained is the leading audit finding in this code family. Count the views in the report, not the views ordered.
• Payer alert: When the same physician bills critical care services (99291/99292), chest X-ray interpretation under 71045 or 71046 performed during the critical period is bundled and may not be billed separately by that physician. Facilities may report separately.
• MUE: 4 units per date of service (CMS NCCI, effective April 1, 2026) [2]; each unit requires a separate physician order and distinct documented clinical indication.

When to Use This Code

CPT 71045 applies when exactly one radiographic view of the chest is obtained and a signed physician interpretation is documented. View type does not affect code selection under the post-2018 structure: AP, PA, lateral, apical lordotic, oblique, and lateral decubitus views each count as a single view under 71045 [4].

Clinical settings where single-view chest radiographs predominate:

• Portable and bedside imaging: The AP view is standard for ICU, inpatient, and ED portable studies where patient mobility limits positioning. This is the dominant use case for 71045 in high-acuity settings.
• Serial monitoring: Critically ill patients receiving multiple daily chest X-rays for ventilator management, acute condition tracking, or interval assessment of known pathology generate multiple 71045 units (up to the MUE of 4 per date).
• Focused clinical evaluation: When a single targeted view addresses the clinical question without requiring a comprehensive multi-view series, 71045 is appropriate.
• Post-procedure assessment: Confirming pneumothorax, effusion, or tube position following thoracentesis or chest tube placement, when only one view is obtained. Note the distinct restrictions for PICC insertion confirmation covered in Section 4.

The single-view code is not typically appropriate for outpatient radiology departments evaluating new or complex pulmonary complaints, where a two-view PA and lateral series (71046) is standard practice. If the clinical scenario results in a PA plus lateral, report 71046 regardless of what was originally ordered.

Code Differentiation Table

The critical differentiator is simple but consistently violated: the signed radiology report controls which code applies. If the order reads "two views" but the technologist obtained only one, 71045 is correct. If the order reads "one view" but the radiologist adds a lateral, 71046 is correct. Auditors pull the report and compare view descriptions to the billed code.

Billing and Modifier Rules

PC/TC Split

CPT 71045 carries PC/TC Indicator 1 (Diagnostic Tests for Radiology Services) [1]. Three billing patterns apply:

• Global (no modifier): Same entity owns the equipment and provides the signed interpretation, such as a freestanding imaging center or physician-owned office with in-house equipment.
• Modifier 26: Interpreting physician or radiologist bills the professional component only; the physician does not own or operate the imaging equipment. Approximately 71.68% of 71045 claims carry modifier 26, reflecting the prevalence of hospital-based radiology.
• Modifier TC: Facility or portable X-ray supplier bills for equipment, film or digital acquisition, and technician services. Portable X-ray suppliers report TC only.

Do not append both modifier 26 and TC from the same entity. The sum of modifier 26 and TC payments equals the global rate.

2026 RVU Reference (CMS MPFS, January 2026) [1]:

Repeat Studies on the Same Date

Serial chest X-rays on the same date require:

• Modifier 76: Repeat study performed and interpreted by the same physician.
• Modifier 77: Repeat study interpreted by a different physician.

Multiple units without these modifiers will trigger automated edits at most payers. Note that modifier 51 does not apply: CMS specifies no multiple procedure payment adjustment applies to 71045 [5].

MUE and Multiple Units

CMS NCCI sets the MUE at 4 units per date of service using a Date of Service Clinical edit [2]. Each unit requires a separate physician order and distinct documentation of the clinical event. Do not consolidate multiple same-day studies into a single claim line without modifiers.

Add-On Code

CPT 0174T (computer-aided detection performed concurrently with primary interpretation) may be added to 71045 when CAD analysis occurs at the time of reading [5]. Do not report 0175T (remote CAD) with 71045 through 71048; CPT guidelines prohibit this combination.

Critical Bundling Rules

Two bundling scenarios generate frequent errors:

1. PICC insertion same-day restriction: Do not report 71045 (or 71046 through 71048) to document final catheter position on the same date as 36572, 36573, or 36584. Those insertion codes include catheter tip location confirmation [5]. Report the insertion code with modifier 52 when tip location was not confirmed. If a separate chest X-ray is ordered on the same date for a distinct clinical indication unrelated to catheter placement, it may be reportable with documentation supporting the separate medical necessity.

2. Critical care bundling: When a physician bills critical care services (99291/99292), interpretation of 71045 or 71046 during the critical period by that same physician is included and may not be billed separately [5]. The same rule applies during pediatric critical care patient transport. Facilities may report 71045 separately.

ASC and Hospital Outpatient Payment

In the ASC setting, 71045 is paid separately when integral to a surgical procedure on the ASC list, based on MPFS nonfacility PE RVUs. In the hospital outpatient setting, 71045 may be paid through a composite APC [1].

Documentation Essentials

Required elements:

• Signed final radiology report with the physician's interpretation and findings. A preliminary or unsigned read does not satisfy Part B payment requirements.
• Explicit statement of the number of views taken (e.g., "single view AP chest radiograph").
• Written or electronic order from the treating physician with a documented clinical indication.
• Patient identity, date of service, and ordering provider documented in the record.

Audit red flags for 71045 specifically:

• View count mismatch: The radiology report describes two distinct projections (e.g., "AP and lateral") but the claim shows 71045. Auditors pull the final report and compare the view description against the billed code. This is the most frequently cited upcoding error in chest radiography audits.
• PICC day conflict: 71045 billed on the same date as 36572, 36573, or 36584 when the only X-ray obtained was to confirm catheter tip position. The PICC insertion codes include tip confirmation; a separate 71045 on the same date requires documentation of a distinct clinical purpose unrelated to catheter placement.
• Multiple units without orders: Billing 71045 at two or more units without separate physician orders for each study and documented clinical events triggering each order.
• Missing signed interpretation: Billing triggered by technologist completion rather than the finalized physician read.
• Routine preoperative billing: Reporting 71045 with Z01.810 or Z01.818 without a clinical finding beyond the scheduled procedure. Medicare does not cover routine preoperative chest X-rays; the order must be based on a specific clinical symptom or finding.

Medical necessity: No NCD restricts 71045 [3]. MAC-level LCDs govern coverage criteria. Common covered indications include respiratory symptoms (cough, dyspnea, chest pain), acute respiratory illness, chest trauma, known pulmonary disease monitoring, and pulmonary nodule follow-up. "Annual" or "wellness" chest X-rays without a supporting clinical finding are not covered under Medicare.

Medicare, Commercial, and Medicaid Payer Rules

Medicare

CMS covers 71045 under Part B when medically necessary with a documented clinical indication [3]. No NCD restricts chest radiography. Coverage is governed by MAC-specific LCDs and general medical necessity standards. Verify current criteria with the applicable MAC (Novitas, NGS, Noridian, Palmetto GBA, CGS, WPS, or First Coast) for jurisdiction-specific diagnosis requirements and coverage articles.

Key Medicare-specific rules:

• Preoperative chest X-rays are not covered as routine preoperative screens. The order must be based on a documented clinical finding, not simply on the fact that surgery is scheduled.
• Physician interpretation of 71045 or 71046 is bundled into critical care professional billing when performed during the critical period by the same physician. Facilities bill separately.
• Portable X-ray suppliers report TC only; the interpreting physician bills modifier 26 separately.
• 71045 may be paid through a composite APC in the hospital outpatient setting. In the ASC setting, 71045 is paid based on MPFS nonfacility PE RVUs when provided integral to a listed surgical procedure [1].

Commercial payers

Most commercial payers follow Medicare coding logic for the 71045 through 71048 family. Notable divergences:

• Automated claim editing systems may flag 71045 billed on the same date as PICC insertion codes regardless of payer tier; a distinct indication must be clearly documented to support separate payment.
• Prior authorization is rarely required for standard chest X-rays, but imaging management programs at some commercial payers apply criteria for repeated imaging within defined timeframes.
• Telehealth context: a remote radiology read of a chest X-ray obtained in a clinic or facility does not change the CPT code reported for the radiograph itself.

Common Denials and Prevention

View count upcoding Auditors identify this when the billed code does not match the number of views in the signed radiology report. Prevention: implement a charge capture workflow that pulls the view count from the finalized report rather than from the order or the technologist's entry. Charge lag protocols should hold chest X-ray billing until the final read is signed in the system.

Missing or unsigned interpretation Claim submitted without a finalized, signed radiology report. Prevention: configure billing holds that require a physician attestation date before a claim generates. Preliminary reads and verbal communications do not satisfy Part B documentation requirements.

PICC same-day denial 71045 denied as included in the PICC insertion code. Prevention: when a chest X-ray is ordered for a distinct clinical purpose on the same date as PICC placement, document the separate clinical indication in the order and ensure the radiology report reflects a distinct clinical question. Appeal with the separate order and report demonstrating the independent medical necessity.

Critical care bundling denial Physician bills modifier 26 for 71045 on the same date as critical care services for the same patient. Prevention: audit charge capture during critical care billing to ensure chest X-ray interpretation charges are suppressed at the physician level. If the X-ray was interpreted by a different physician outside the critical care period, document the distinct provider and timing clearly.

Medical necessity denial for routine preoperative imaging 71045 denied with Z-code indications (preprocedural examination) under Medicare. Prevention: code to the specific clinical condition that prompted the order (e.g., J44.1, R06.09), not to the preprocedural encounter code. Document the clinical finding in the order and the medical record.

Coding Scenarios

Scenario 1: Portable ICU chest X-ray following subclavian central line placement A patient in the medical ICU has a subclavian central venous catheter placed. The intensivist orders a portable AP chest X-ray to rule out pneumothorax. The radiologist interprets the film and documents a single AP view with no pneumothorax.

Correct coding: 71045-26 (radiologist); 71045-TC (facility); diagnosis: Z45.2 or primary admission diagnosis

Why: Subclavian CVC placement is not subject to the PICC bundling restriction (36572/36573/36584). The X-ray is separately reportable. One view was documented, so 71045 applies. The hospital-based radiologist bills modifier 26; the facility bills TC.

Scenario 2: Three portable chest X-rays, ICU patient with ARDS An ICU patient with ARDS receives portable AP chest X-rays at 0600, following a ventilator adjustment at 1100, and after an acute desaturation event at 2000. The attending physician places a separate order for each study. The same radiologist interprets all three.

Correct coding: 71045 (first study); 71045-76 (second study); 71045-76 (third study); diagnosis: J80 for each

Why: Three units are within the MUE of 4 [2]. Each requires a separate order and documented clinical event. Modifier 76 identifies the repeated interpretations by the same radiologist. Each claim line must have its own order reference and distinct clinical rationale.

Scenario 3: ED visit for cough and fever An ED patient presents with productive cough and fever for three days. The emergency physician orders a chest X-ray. The radiologist obtains a PA view only. The signed report reads "single view PA chest radiograph, bilateral lower lobe infiltrates consistent with pneumonia."

Correct coding: 71045-26 (radiologist); 71045-TC (hospital); diagnosis: J18.9

Why: One view is documented in the signed report. Had the radiologist obtained a lateral view in addition, 71046 would apply regardless of what was ordered. The clinical diagnosis drives the ICD-10-CM selection after the radiologist's findings are finalized.

Scenario 4: PICC insertion with a separate same-day chest X-ray for acute dyspnea A patient has a PICC placed (36572) with catheter tip confirmation included. Later that afternoon, the pulmonologist orders a separate chest X-ray because the patient develops acute shortness of breath. A single AP view is obtained and interpreted as showing a new right-sided pleural effusion.

Correct coding: 36572 (PICC insertion); 71045-26 with modifier 59 or XE (separate encounter) for the afternoon study; 71045-TC (facility); diagnosis: J90 (pleural effusion)

Why: The PICC insertion code includes catheter tip confirmation, so no 71045 is reportable for that purpose. The afternoon study is a distinct clinical event with a separate order, separate indication, and separate signed report. Documentation of the distinct timing, provider order, and clinical question is essential to sustain the separate 71045 claim on appeal if denied.

Related Codes

• 71046 — Chest X-ray, 2 views; standard outpatient series and most commonly upcoded alternative to 71045
• 71047 — Chest X-ray, 3 views; three views documented; MUE of 1 per date
• 71048 — Chest X-ray, 4 or more views; packaged in the ASC setting
• 0174T — Computer-aided detection, concurrent with primary interpretation; add-on to 71045
• 0175T — Computer-aided detection, remote from primary interpretation; do not report with 71045 through 71048
• 36572 — PICC insertion without port or pump, age 5 or older; includes catheter tip confirmation, which restricts same-day 71045 for that purpose
• 36573 — PICC insertion without port or pump, under age 5; same tip confirmation bundling restriction applies
• 36584 — Replacement of PICC without subcutaneous port or pump; same tip confirmation bundling restriction applies
• 99291 — Critical care, first 30 to 74 minutes; physician interpretation of 71045 during the critical period by the same physician is bundled

Sources

1. CMS 2026 Medicare Physician Fee Schedule, RVU File (PPRRVU2026_Jan_nonQPP.csv). January 2026. RVU values for 71045 global, modifier 26, and TC components; ASC and APC payment indicators.
2. CMS NCCI, MUE Practitioner Services File (MCR_MUE_PractitionerServices_Eff_04-01-2026.csv). April 1, 2026. MUE value of 4 for 71045, Date of Service Clinical edit.
3. CMS Medicare Coverage Database, LCDs for Radiology. No NCD restricts 71045; coverage governed by MAC-level LCDs and general medical necessity standards.
4. AMA CPT Code Set, 2018 Chest X-Ray Restructuring. 2018. Deletion of 71010 through 71034; addition of view-count codes 71045 through 71048 effective January 1, 2018.
5. Coding Ahead CPT Database. March 2026. Official descriptions, PC/TC indicators, CPT guidelines, add-on code relationships, and PICC bundling rules for 71045 through 71048.