Current Procedural Terminology (CPT) codes standardize medical services for billing and communication with insurance payers. CPT code 70450 specifically identifies a Computed Tomography (CT) scan of the head or brain. This code signifies the procedure was performed without contrast material, a dye typically injected to enhance tissue visibility. The non-contrast head CT is a foundational diagnostic tool in emergency medicine for quickly assessing the internal structures of the cranium.
The Procedure Defined: CT Scan of the Head
A CT scan uses a series of X-ray beams taken from multiple angles around the head. A computer processes this data to create detailed cross-sectional images, or “slices,” of the brain and skull. This technology excels at visualizing bone structures and acute changes in tissue density, such as fresh blood, offering a much clearer view of the internal anatomy than a standard X-ray.
The defining characteristic of CPT 70450 is the exclusion of contrast material. Contrast is typically an iodine-based solution injected intravenously to highlight blood vessels, tumors, or areas of inflammation. When looking for acute conditions like bleeding or fractures, the natural density differences are sufficient for diagnosis, making the contrast unnecessary.
Avoiding contrast eliminates the potential for allergic reactions or complications in patients with pre-existing kidney issues, since the dye is processed by the kidneys. Non-contrast scans are also faster to perform, making them the preferred initial choice in emergency situations. The speed and clarity of bone and acute hemorrhage visualization make this scan essential in hospital emergency departments.
Medical Reasons for the Scan
The non-contrast CT head scan is ordered for the rapid evaluation of neurosurgical emergencies and acute neurological symptoms. A primary indication is acute head trauma, where the scan is essential to rule out life-threatening conditions like intracranial hemorrhage (bleeding within the skull) and skull fractures. Fresh blood appears distinctly bright on this CT, allowing for quick diagnosis and intervention.
This procedure is also the first-line imaging test for patients presenting with suspected stroke. The immediate goal is to differentiate between an ischemic stroke (a clot) and a hemorrhagic stroke (a bleed). This distinction is crucial because the treatment for an ischemic stroke (clot-busting medication) is dangerous if a hemorrhage is present. Severe or sudden onset headaches also prompt this scan to investigate for a subarachnoid hemorrhage (bleeding around the brain).
Other common reasons for the scan include:
- Evaluating new-onset seizures.
- Unexplained changes in mental status or progressive memory loss.
- Checking for shunt malfunction in patients managing hydrocephalus (excess brain fluid).
- Assessing bone abnormalities and complex sinusitis.
What to Expect During the Examination
The CT head scan is a relatively quick and non-invasive procedure. Before the scan, the patient must remove metal objects, such as jewelry or eyeglasses, as metal can interfere with the X-ray beams and distort the images. Since CPT 70450 is a non-contrast study, there are typically no dietary restrictions or special preparations needed.
The patient is positioned on a narrow table that slides into the center of the CT machine, a large, donut-shaped device. The technologist aligns the patient’s head and may use straps or foam pads to minimize movement. Remaining completely still is important for image clarity, as movement can blur the fine details of the brain structure.
The scanning process itself often lasts only a few minutes. During the scan, the X-ray tube rotates around the patient’s head, acquiring the necessary image data. A technologist monitors the procedure from an adjacent room but communicates with the patient through an intercom. Once the scan is complete, the resulting images are sent to a radiologist, a physician who specializes in interpreting medical images, who analyzes the slices and prepares a formal report.
Understanding the Billing Implications
CPT code 70450 functions as the administrative identifier describing the service rendered to the insurance company or payer. This code communicates that the patient received a CT scan of the head without contrast, establishing the medical service for reimbursement. Payment for this procedure is often divided into two parts: the technical component and the professional component.
The technical component (TC) covers the costs associated with performing the scan, including the use of the CT machine, supplies, and the technologist’s salary. The professional component (Modifier 26) covers the physician’s services, which include supervising the procedure, interpreting the final images, and generating the written report. When a facility owns the equipment and employs the interpreting physician, they typically bill a single “global fee” for the complete service.
The patient’s final financial responsibility is determined by their insurance plan’s specific coverage for CPT 70450. This responsibility may involve satisfying a deductible, paying a co-payment, or covering a percentage of the allowed amount as coinsurance. The ordering physician must clearly document the medical necessity for the non-contrast scan to ensure the insurance company approves the claim.