Non-contrast CT of the soft tissues of the neck, such as the airway, glands, lymph nodes, and muscles, separate from imaging of the cervical spine.
- Medicare
- $149.64
- Work RVU
- 1.25
- Global, days
- Region
- Other
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Order that names soft tissue neck, not cervical spine
- Clinical reason, such as post-op swelling, dysphagia, or a mass
- Surgical history when ordered after anterior cervical surgery
- Separate order if cervical spine CT is also needed
- Signed report
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
70490 is a CT of the neck soft tissues without contrast. It looks at the airway, thyroid, salivary glands, lymph nodes, and soft tissue masses. It is not a cervical spine study.
That distinction is the whole reason this page matters to an orthopedic practice. When a surgeon or staff member writes "CT neck" on an order, the scheduling team may book 70490 when the surgeon wanted the bones. A cervical spine CT without contrast is 72125. A 70490 performed for neck pain after a fall will not answer the surgeon's question, and the claim will not match the diagnosis.
There are real ortho uses. A post-op anterior cervical fusion patient with swelling, trouble swallowing, or a suspected hematoma or abscess may need soft tissue neck imaging, often with contrast (70491). Write the order with the specific concern. If a patient needs both the spine and the soft tissues, they are two codes and need two orders.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (1.25) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.48) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.25 |
| Practice expense RVU | 3.15 |
| Malpractice RVU | 0.08 |
| Total RVU | 4.48 |
| Medicare national rate | $149.64 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $149.64 |
HOPD (APC 5522) Hospital outpatient department | $106.81 |
Common denial reasons
The recurring reasons claims for CPT 70490 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Diagnosis is cervical spine pain or fracture, which supports 72125, not 70490
- Wrong study scheduled from a vague "CT neck" order
- Billed with 72125 without separate orders
- Prior authorization obtained for a different code
- Global billed in a facility setting
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is 70490 a cervical spine CT?
02When would a spine surgeon order 70490?
03Can 70490 and 72125 be billed together?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records the exact study the surgeon asks for, cervical spine or soft tissue neck, and the reason, which cuts down on wrong-study scheduling.
See how Mira captures CPT 70490 documentation