CPT® Code 71250

Last Updated: February 2026 | Verified for 2026 AMA, CPT & CMS Guidelines

Quick Reference: CPT 71250 (CT Chest Without Contrast)

• Code definition: CPT 71250 describes a diagnostic computed tomography (CT) study of the thorax performed without contrast material. It covers cross-sectional imaging of the lungs, mediastinum, pleura, and chest wall, and is routinely used when contrast is not needed or is contraindicated (e.g., renal dysfunction, contrast allergy). AAPC’s CPT summary describes the service as a CT thorax performed without contrast .
• Professional vs technical billing: 71250 may be billed globally (single entity provides both scanning and interpretation) or split into professional and technical components using 26 and TC rules described in Medicare radiology billing guidance .
• Medical necessity focus: Medicare covers CT when it is reasonable and necessary for diagnosis or treatment; local coverage is defined through LCD criteria and diagnosis-code listings for chest CT services .
• Screening is different: Diagnostic 71250 is not a screening lung cancer CT code. Lung cancer screening uses 71271 and separate coverage requirements; major billing guidance notes that 71250–71270 are not used for screening LDCT under current rules .
• Frequency & repeat imaging: Chest CT repeats are scrutinized. Medicare coverage articles/LCD guidance commonly include utilization guardrails and extensive ICD-10 lists supporting the service; repeated imaging should be justified by interval change, complications, or new symptoms . CPT 71250 is the core code for a diagnostic CT of the chest performed without contrast. The billing risk with 71250 rarely comes from the scan technique itself (non-contrast CT is common and clinically appropriate in many thoracic problems). Instead, denials usually arise from four preventable issues: (1) the claim reads like a screening service, (2) documentation does not clearly establish why CT is needed after initial evaluation, (3) the wrong contrast variant is billed (71250 vs 71260 vs 71270), or (4) the professional/technical split is miscoded. Medicare’s thorax CT LCD and the associated billing/coding article are the practical anchor for compliance because they spell out what diagnoses and clinical contexts typically support payment for CT thorax services .

This 2026 guide keeps the focus on what payers actually check: medical necessity (the “why”), protocol accuracy (contrast usage), and component billing (who did what). Where relevant, this article points to Medicare’s thorax CT policy materials and radiology billing rules, plus an evidence-based imaging guideline resource for follow-up interval logic in common scenarios such as pulmonary nodules .

1. Definition & Components of CPT 71250

CPT 71250 is “Computed tomography, thorax; without contrast material.” In operational terms, it describes a diagnostic CT acquisition of the thorax performed without administration of contrast. AAPC’s code summary emphasizes that the provider performs a CT of the thorax without using contrast . The study typically includes thin-section axial images with routine reconstructions (for example, multiplanar reformats) that are considered inherent to the base CT service.

The anatomic coverage of a “CT chest” is payer-relevant because it supports why 71250 is billed rather than a more limited service. A typical scan extends from the lung apices through the lung bases and often includes the adrenal region if the facility protocol uses a standard thorax range. Clinically, this supports evaluation of pulmonary parenchyma, pleura, airways, and mediastinal structures. Importantly, high-resolution chest CT protocols used for interstitial lung disease evaluation do not have a separate CPT code; the base CT thorax code is used and the “without contrast” status determines whether 71250 is correct.

Global vs split billing (professional and technical components)

Like most diagnostic radiology services, 71250 has separate professional and technical components. The technical component is the equipment, technologist time, supplies, and facility overhead required to acquire the images. The professional component is the physician interpretation and the written report. Medicare’s radiology billing guidance describes the professional/technical component split and the rules for reporting these components using modifiers .

This split matters because many denials are “duplicate payment” denials: one party bills globally and another bills 26 or TC, or the same party bills both components incorrectly. A clean way to prevent this is to define workflow clearly:

(a) freestanding imaging center performs both scanning and interpretation and bills globally (no modifier), or

(b) facility bills 71250-TC and the interpreting physician bills 71250-26. Medicare’s radiology manual guidance is the best baseline reference for how component billing is handled in claims processing .

Practical compliance note: A payer does not need to see the contrast protocol to deny a claim if the report is inconsistent with the billed code. The report should explicitly state “without IV contrast” when 71250 is billed. If the report documents contrast administration, the payer can downcode or deny the 71250 claim and request a corrected claim for 71260 or 71270 (depending on whether a diagnostic non-contrast phase was also obtained).

2. Documentation Requirements

Documentation for 71250 must support two separate questions that payers care about: (1) Was CT clinically justified? and (2) Was the billed code an accurate description of what was done? Medicare’s thorax CT LCD and billing/coding article illustrate how payers operationalize “reasonable and necessary” in this category by listing covered indications and ICD-10 codes used as medical-necessity anchors .

Ordering documentation: show why CT is the next step

The order should specify “CT chest without contrast” (or equivalent) and include a clinical indication that matches the patient’s story (symptoms, abnormal prior imaging, cancer history, infection concern, etc.). Many payer guidelines assume CT is not the first test for routine chest symptoms; the chart should show why CT is needed (for example, persistent symptoms despite initial evaluation, or abnormal radiograph requiring characterization). When the claim is reviewed, the order and the clinical note often function as the “medical necessity packet.” If the note is generic, the payer can treat the CT as low-value utilization and deny it even when the imaging result is clinically useful.

Radiology report: make the billed service auditable

For a non-contrast CT, the report should include (1) technique (explicitly stating no contrast), (2) findings, and (3) impression. If prior images are compared, include the comparison date and the clinically meaningful interval change. If the patient has renal dysfunction or another reason contrast was avoided, noting that context can reduce payer questions when the indication is one where contrast might otherwise be expected (for example, staging known malignancy). Medicare radiology processing guidance emphasizes the importance of correct reporting and claim information for diagnostic imaging services .

Follow-up CTs: document interval logic and why the timing makes sense

Repeat chest CTs are common in pulmonary nodule surveillance, oncology follow-up, and evaluation of evolving infections or complications. Repeats become vulnerable when timing is too frequent or the chart does not explain what changed. When nodule follow-up is the reason, documenting that the interval aligns with an accepted guideline framework strengthens defensibility. Carelon’s chest imaging guideline resource summarizes follow-up logic used in many utilization management programs, including pulmonary nodule interval concepts . The point is not to cite a guideline for every case, but to show that follow-up timing is grounded and clinically motivated rather than routine “repeat scanning.”

Screening vs diagnostic: use the correct code and language

If the intent is lung cancer screening in an eligible asymptomatic high-risk patient, the correct code is 71271 (LDCT screening) with its own rules. The American Lung Association’s billing guide emphasizes that screening LDCT uses 71271 and that 71250–71270 are not used for screening in current billing frameworks . If the medical record describes the service as “screening” but the claim uses 71250, a denial is likely, even if the patient has risk factors, because the code/coverage pathway is mismatched.

3. Medicare & Payer Coverage Guidelines

For Medicare, chest CT coverage is implemented locally through LCDs and related billing/coding articles. Palmetto GBA’s thorax CT LCD is a commonly referenced example that outlines indications and limitations for CT thorax services and provides policy language about when CT is covered versus when it is considered screening . The companion article lists extensive ICD-10 codes that support medical necessity for 71250/71260/71270 and is often where denials are adjudicated (if the ICD-10 on the claim is not on the supported list, the claim can deny) .

How Medicare decides “reasonable and necessary” in practice

Medicare’s practical approach in radiology is claims-based: the CPT describes the service and the ICD-10 diagnoses justify it. The thorax CT LCD and article show common diagnostic categories that support payment (abnormal imaging findings, suspected infections with complications, known malignancy evaluation, and other clinically significant thoracic conditions) . This is why “tight” diagnosis coding matters: an overly vague symptom code can be paid in one patient and denied in another depending on the MAC’s LCD logic and the claim’s accompanying details.

Commercial payer behavior: prior authorization and guideline alignment

While Medicare typically does not use prior authorization for standard diagnostic CT in the same way many commercial plans do, commercial payers frequently require preauthorization for outpatient CT. Their criteria are often derived from imaging guideline frameworks similar to those summarized in Carelon’s imaging guidance resources, which are designed for utilization management workflows and include scenario-driven rules (for example, when CT is appropriate after initial work-up) . Practically, this means the same documentation that supports Medicare (clear indication, abnormal prior imaging, red-flag symptoms, or failure of initial treatment) also supports commercial approvals.

Screening denials: the most avoidable problem

Medicare policy materials explicitly separate diagnostic CT from screening. If a claim appears to be a routine screen, payment can be denied under screening exclusions and because it does not meet diagnostic medical necessity. The correct preventive pathway is the lung cancer screening program (71271 plus the required supporting documentation and eligibility). The ALA billing guide is a payer-facing summary that helps prevent miscoding (71250 billed for screening) .

4. Proper Use of Modifiers 26, TC, 59

Modifiers on 71250 are not “optional formatting”; they are how payers decide whether the claim is the professional interpretation, the technical scan, or the global service. Medicare radiology processing rules describe how component billing is recognized in claims and how payment is split between the two components .

Modifier 26 (professional component)

Append -26 when billing only the physician interpretation and report. This is typical when the imaging facility owns the scanner and performs the acquisition, while a radiologist (or teleradiology group) provides the reading. The report must exist and be signed/attested according to the payer’s standards. If a global claim has already been paid, a 26 claim may deny as duplicate.

Modifier TC (technical component)

Append -TC when billing only the technical acquisition (equipment, staffing, supplies). This is typical for hospitals or imaging centers when the interpreting physician bills separately. Medicare processing guidance describes component billing mechanics and is commonly used to resolve “who bills what” questions for diagnostic radiology services .

Modifier 59 and repeat imaging logic

Modifier 59 is used to indicate a distinct procedural service when separate studies would otherwise be treated as duplicates or bundled. For CT, the most common legitimate uses are:

(1) truly separate CT services performed in separate sessions for separate clinical reasons, or

(2) a diagnostic CT distinct from a CT-guided procedure performed later the same day where documentation supports that the diagnostic study was independent of procedural guidance. The key compliance principle is to avoid using 59 as a “denial override.” If two CT scans of the same region are performed, first confirm whether the correct code is actually the combined “with and without” code (71270) rather than two separate codes. Medicare bundling logic generally expects the combined code when both phases are performed as one exam .

Medicare-specific CT equipment modifier

Separate from CPT code 71250 and the 26/TC split, Medicare includes a CT-related payment policy for certain scanner compliance categories that can affect technical reimbursement. Medicare’s radiology manual discusses CT-related processing and policy mechanics relevant to claims submission in this category . In practice, imaging facilities should ensure their billing systems are aligned with current Medicare requirements for CT claims, because a technical claim can be reduced even when the medical necessity is unquestioned.

5. 71250 vs 71260 vs 71270 – Contrast Variants

The thorax CT family has three primary diagnostic codes distinguished by contrast usage. Selecting the correct one is a high-impact compliance issue because payers can validate the contrast protocol directly from the radiology report.

The compliance rule is simple: if both diagnostic phases were performed as one exam (a meaningful non-contrast phase and then a meaningful contrast phase), use 71270 rather than billing 71250 and 71260 separately. Medicare’s radiology claims processing guidance is consistent with the broader “more comprehensive code” approach in radiology billing and supports why unbundling is typically rejected . The radiology report should clearly document the protocol (for example, “images obtained without IV contrast, then after IV contrast administration additional images obtained”) whenever 71270 is billed.

Separately, note that CT angiography (CTA) is not coded with 71260. CTA uses distinct codes and protocols; if the intent is vascular evaluation (e.g., pulmonary embolism), a CTA code is usually appropriate. The most defensible approach is to align the CPT with the protocol order and the report: “CTA” should read like CTA, not a standard contrast CT.

6. Clinical Scenarios

The following scenarios illustrate typical “clean” use of 71250 and the documentation elements that reduce denials. These examples are not payer rules by themselves; they model how to make the claim and the chart tell the same story.

Scenario 1: Pulmonary nodule characterization after abnormal radiograph

Patient: 62-year-old with a new solitary pulmonary nodule reported on chest X-ray.

Order/Reason: “CT chest without contrast to characterize nodule seen on radiograph.”

Why 71250 fits: Non-contrast CT is often sufficient to characterize size, margins, and calcification patterns, and it avoids contrast risk when contrast is unnecessary.

Documentation tip: Include the prior X-ray date/result in the note and reference guideline-based follow-up concepts if surveillance is planned; utilization management frameworks often use guideline logic for follow-up intervals .

Scenario 2: Interstitial lung disease evaluation (HRCT protocol)

Patient: 55-year-old with progressive dyspnea and restrictive PFTs; clinician suspects interstitial lung disease.

Order/Reason: “High-resolution CT chest without contrast for ILD evaluation.”

Why 71250 fits: HRCT is coded with the standard thorax CT code that matches contrast use; when no contrast is given, 71250 is appropriate (no separate HRCT CPT).

Documentation tip: State why CT is needed beyond initial work-up (symptoms + PFT pattern) and ensure the report clearly states “without IV contrast.”

Scenario 3: Non-resolving pneumonia / suspected complication without contrast

Patient: 73-year-old with pneumonia symptoms not improving after treatment; concern for abscess or empyema; renal function limits IV contrast.

Order/Reason: “CT chest without contrast to evaluate persistent opacity and rule out complication; contrast avoided due to renal dysfunction.”

Why 71250 fits: Non-contrast CT can still identify cavitation, fluid collections, pleural effusion, and other complications; the choice to omit contrast is clinically explained.

Coverage anchor: Medicare LCD/Article frameworks for thorax CT services include broad diagnostic categories and ICD-10 code support logic used in claims adjudication .

Scenario 4: Repeat CT in a separate session (avoid accidental unbundling)

Patient: Hospital outpatient returns the same day due to new acute symptoms after an earlier CT chest without contrast.

Order/Reason: New symptoms justify a second study as a separate clinical service (not a completion of the first exam).

Billing caution: If the second imaging is simply “adding contrast” to complete the initial work-up, the correct coding is often one combined exam (71270), not two separate CT codes. If there were truly two distinct sessions with distinct medical necessity, documentation must show the separation and the reason.

7. State Medicaid Variations (CA, NY, TX, FL)

Medicaid coverage is state-administered and frequently managed through contracted health plans. The safest approach is to treat outpatient CT as an authorization-controlled service unless you have a state-specific exception. Below are practical highlights using authoritative state/contractor references for California and Texas, plus general operational guidance for New York and Florida where rules commonly depend on the member’s managed care plan.

California (Medi-Cal)

In California, policy communications to providers have stated that prior authorization (TAR) continues to be required for CT scans of the chest/abdomen/pelvis in relevant contexts. A Partnership HealthPlan provider notice explicitly states that TARs continue to be required for CT scans of the chest, abdomen, and/or pelvis . Operationally, this means the ordering documentation (indication, relevant prior imaging, symptom persistence, etc.) should be assembled early so the authorization request is supportable.

Texas (Texas Medicaid / TMHP context)

Texas Medicaid documentation has described thresholds where prior authorization is not required for up to a limited number of CT imaging procedures per year, with CT services listed in the diagnostic radiology chapter of the Texas Medicaid provider manual . Even where prior authorization is not required within a threshold, documentation still matters for post-payment review. The practical best practice is to chart the reason for the CT and why CT (rather than repeat radiography) is needed in the specific patient.

New York (general operational guidance)

New York Medicaid members are frequently enrolled in managed care, and outpatient advanced imaging commonly requires plan authorization. Because program structure can differ by coverage type (fee-for-service vs managed care), providers should confirm authorization requirements for the member’s specific plan and eligibility category before scheduling outpatient CT. If authorization is required, the clinical justification in the order and progress note becomes the approval foundation.

Florida (general operational guidance)

Florida Medicaid is also predominantly managed care in practice, and advanced imaging (including CT) is commonly subject to prior authorization. As with New York, plan rules can vary, but the operational principle remains stable: obtain authorization when required, and ensure the chart clearly supports medical necessity for a diagnostic (not screening) CT.

High-yield Medicaid billing tip: If the exam is screening LDCT, do not attempt to “force it through” as 71250. Screening has its own code and pathway; the LDCT billing pathway is summarized in the lung cancer screening billing guide .