Diagnostic CT of the chest without intravenous contrast, imaging the lungs, mediastinum, and chest wall for a specific clinical question rather than screening.
- Medicare
- $132.60
- Work RVU
- 1.05
- 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 naming chest, not thoracic spine
- Clinical reason, such as sternal fracture, chest wall mass, or staging
- Separate order and report if a thoracic spine CT is also billed
- Mechanism of injury in trauma
- 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 ↓
71250 is a diagnostic chest CT without contrast. It images the lungs, mediastinum, and chest wall. It is not a thoracic spine CT.
That confusion is why this code matters to orthopedics. A spine surgeon who wants the thoracic vertebrae needs 72128 (thoracic spine CT without contrast). A chest CT does show the spine, but it is reconstructed and read for the chest, and the payer will match the code to the diagnosis. A thoracic compression fracture billed under 71250 is a mismatch.
There are real ortho uses: sternal fractures, chest wall masses, rib fracture patterns in trauma, and metastatic workups for a patient with a pathologic fracture. Scapula and glenoid fractures are usually imaged with an upper extremity CT (73200), not a chest CT. Trauma scans are where this gets audited. If the thoracic spine images were reformatted from the chest scan, do not add 72128 unless the spine study was separately ordered and reported and the payer's written policy allows it.
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 (1.05) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.97) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.05 |
| Practice expense RVU | 2.85 |
| Malpractice RVU | 0.07 |
| Total RVU | 3.97 |
| Medicare national rate | $132.60 |
| 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 | $132.60 |
HOPD (APC 5522) Hospital outpatient department | $106.81 |
Common denial reasons
The recurring reasons claims for CPT 71250 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Thoracic spine diagnosis billed under a chest CT code
- Billed with 72128 from one scan without separate reconstruction and report
- Prior authorization for a different code
- Diagnosis does not support chest imaging
- Missing modifier 26 for a facility read
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is 71250 used for a thoracic spine CT?
02Can a chest CT and thoracic spine CT be billed from one trauma scan?
03What CT code is used for scapula fractures?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records whether the surgeon is asking about the spine or the chest, so the order and the claim point to the same body region.
See how Mira captures CPT 71250 documentation