CPT code 70487 – Maxillofacial CT with contrast

Key takeaways

CPT code 70487 covers maxillofacial CT with contrast, and the radiology report must document the contrast or the claim is downcoded to 70486.

Three sibling codes split the family by contrast protocol: 70486 without, 70487 with, and 70488 without then with. Bill only one per study.

Medicare Advantage and most commercial plans require prior authorization for 70487, and a missing authorization number is a frequent denial cause.

Medicare’s 2026 national non-facility payment for 70487 is about $150, based on 4.54 total RVUs.

Place of service decides the split: POS 11 bills globally, while hospital outpatient settings pair the radiologist’s modifier 26 with the hospital’s OPPS claim.

CPT code 70487 covers a contrast-enhanced CT of the face

CPT code 70487 reports a CT scan of the maxillofacial area performed with contrast material. The official AMA descriptor reads Computed tomography, maxillofacial area; with contrast material(s). It sits in the Radiology section of CPT, within the head and neck CT range.

The maxillofacial area covers the facial bones, mandible, maxilla, paranasal sinuses and temporomandibular joints. A head CT, billed with 70450 to 70470, images the brain and skull instead. A dedicated orbit study has its own codes too, 70480 to 70482.

Contrast is what separates 70487 from its siblings. Under CPT radiology guidelines, “with contrast” means contrast given intravascularly, intra-articularly or intrathecally. Oral or rectal contrast on its own doesn’t qualify, so that study is reported as 70486.

The chart below turns that rule into two questions, then adds the place-of-service check that decides who sends the bill.

Contrast belongs on 70487 orders that ask about soft tissue

Contrast earns its place when the clinical question is about soft tissue, infection or a mass. Typical 70487 orders include:

• Suspected abscess or deep-space infection of the face or jaw
• Sinusitis with suspected spread into the surrounding soft tissue
• Sinonasal, salivary or jaw tumors that need staging
• Vascular or soft-tissue lesions of the face

Facial fractures, routine chronic sinusitis and dental implant planning usually need no contrast, so they’re normally ordered as 70486. If the order and the protocol disagree, settle it before the scan. Billing a non-contrast acquisition as 70487 is incorrect coding that can trigger overpayment recovery.

3D work trips coders up as well. Routine multiplanar reformats from the same dataset are part of 70487 and aren’t billed separately. A separately ordered 3D rendering, done under physician supervision, is reported with 76376 or 76377 when documented.

The radiology report has to prove contrast was given

Missing contrast documentation is a frequent reason 70487 gets downcoded to 70486. Auditors read the radiology report first. If it doesn’t say contrast was administered, the claim is treated as a non-contrast study, whatever the order said.

A clean claim for CPT code 70487 needs these pieces to line up:

• Clinical indication: the referral or requisition says why the scan is needed and matches the ICD-10 code on the claim.
• An order that says “with contrast”: “CT maxillofacial” alone leaves the protocol open to question.
• A contrast note in the report: the agent, the route (usually intravenous), the volume or dose, and the time given.
• Contrast screening: allergy and kidney function checks for iodinated contrast. If contrast was withheld after the order, the code becomes 70486.
• A signed final report: the interpreting radiologist’s signed report is the main claim-support document.

A structured report template helps here. Give it a required contrast field, and the radiologist can’t sign the report without the contrast details.

Diagnosis codes decide whether contrast was necessary

Payers judge medical necessity for CPT code 70487 at the diagnosis level. They ask whether the ICD-10-CM code supports a contrast-enhanced scan of the face. A weak or mismatched diagnosis can sink a correctly coded procedure.

Coverage rules vary by Medicare Administrative Contractor (MAC). A diagnosis listed under one LCD may be missing from another. Check your MAC’s active policy before you bill an implant planning scan.

Medicare pays about $150 for CPT code 70487 in 2026

Medicare pays CPT code 70487 under the Medicare Physician Fee Schedule (MPFS). The rate is total RVUs times the conversion factor, adjusted by the geographic practice cost index (GPCI) for your locality.

For 2026, 70487 carries 4.54 total non-facility RVUs. At the $33.4009 conversion factor, that gives a national payment of $151.64. In 2025, at a $32.3465 conversion factor, the same scan paid about $147.

Use the CMS lookup to pull the 26 and TC split for your locality. Commercial plans often price radiology as a percentage of Medicare, but contracted rates vary by plan.

Modifiers tell the payer which part of the scan you did

Each modifier on CPT code 70487 tells the payer which part of the service you performed, and so who gets paid. The AAPC lists these as the ones that apply to this code family.

Place of service decides global or split billing

Whether you bill CPT code 70487 globally or split it depends on who owns the scanner and where the scan happens. Check the place of service code before you pick a modifier.

Bill globally when one entity does both parts

Global billing fits when one entity owns the CT scanner, employs or contracts the radiologist, and performs both the scan and the read. A freestanding imaging center set up this way bills 70487 with no modifier. POS 11 (office) tells the payer the non-facility MPFS rate applies.

Split the bill in hospital outpatient settings

Split billing applies when two entities provide the two parts. In a hospital outpatient department, the radiologist bills 70487-26. The hospital bills the technical side through OPPS (Outpatient Prospective Payment System), not with modifier TC.

Use POS 22 for an on-campus department and POS 19 for an off-campus one. A radiologist who bills globally in either setting faces denial or recoupment on audit.

Prior authorization depends on the plan, not traditional Medicare

Traditional Medicare has no precertification for CPT code 70487. CMS paused the Appropriate Use Criteria (AUC) program and rescinded its rules in the CY2024 fee schedule final rule, effective January 1, 2024. So no AUC consultation number goes on the claim.

Medicare Advantage and commercial plans are a different matter. ForwardHealth (Wisconsin Medicaid) lists 70487 on its advanced imaging precertification list. Blue Cross Blue Shield of Massachusetts includes it in the Carelon (formerly AIM) head and neck imaging code list.

Payers that commonly require precertification for this code include:

• Medicare Advantage plans, most of which run advanced imaging programs
• Cigna, through eviCore
• Aetna, through its radiology benefit management program
• UnitedHealthcare, through Optum
• BCBS plans that use Carelon (formerly AIM) or a similar vendor
• State Medicaid programs with imaging management, such as ForwardHealth in Wisconsin

Rules change each plan year and differ between HMO, PPO and Medicare Advantage products, so check the current policy before each scan. A missing or invalid authorization number is a frequent denial cause for this code family. A clear prior authorization process captures that number before the patient arrives.

NCCI edits stop 70487 sharing a claim with its siblings

The National Correct Coding Initiative (NCCI) decides which codes can share a claim. For CPT code 70487, the rules that matter most involve the other maxillofacial CT codes.

• 70487 with 70488: 70488 already includes a contrast phase. Billing both for the same site and date is unbundling, and the payer pays 70488 only. Bill 70488 when both phases were done.
• 70486 with 70487: billing both for the same area on the same date isn’t appropriate. If both phases were acquired, 70488 is the single correct code. A non-contrast series added later for a clinical change needs a documented reason, and the pair still gets reviewed.
• 70487 with a head CT (70450-70470): these are separate sites, so both can be billed when separate indications drive each study. Modifier 59 may be needed for same-session imaging. Keep separate orders and indications in the record.

NCCI tables update quarterly, and an edit’s status can change between updates. Check each pair against the current CMS tables rather than last year’s cheat sheet.

Common 70487 denials and how to appeal them

Each 70487 denial pattern has its own fix. Track them by Claim Adjustment Reason Code (CARC), and use our guide to denial codes to read each one. That shows which denials need an appeal and which need a workflow change.

• Contrast not documented (downcoded to 70486): send the original report with the appeal. If it clearly states contrast was given, the denial is a processing error. If it’s vague, some payers accept a signed radiologist addendum within the timely filing window.
• Missing or invalid prior authorization: if you had approval but left the number off, resubmit a corrected claim with it. If you had none, cite clinical urgency or the policy’s exception clause. A peer-to-peer review with the medical director often reverses urgent imaging denials.
• Medical necessity (ICD-10 mismatch): appeal with records showing the documented indication. If the diagnosis was miscoded, send a corrected claim. For implant planning, check the active LCD first.
• Unbundling (70487 with 70488): 70488 already covers both phases. Review the protocol and bill 70488 alone if both were performed.
• Duplicate claim from a bad split: a radiologist billing global at a hospital, while the hospital bills the technical side, creates a duplicate. Correct the radiologist’s claim to 70487-26 and resubmit.

Check these points before you submit a 70487 claim

How a clean claim moves

Say a patient is referred with a suspected dental abscess spreading into the cheek. The referral records the abscess, and the order reads “CT maxillofacial with contrast”. The radiologist documents the IV contrast agent, dose and time, then signs the report.

The freestanding center bills 70487 globally at POS 11, with the abscess diagnosis attached. The plan’s authorization number goes on the claim, and it pays on first pass.

The pre-submission checklist

• The report names the contrast agent, route, dose and time.
• The order says “with contrast” and matches the protocol performed.
• Only one of 70486, 70487 or 70488 appears for this study.
• The ICD-10 code explains why contrast was needed.
• The prior authorization number is on the claim, for plans that need one.
• The modifier matches the place of service: none at POS 11, and 26 at POS 22 or 19.
• No LT or RT modifier is appended.

How claims software keeps 70487 claims moving

Many 70487 denials start with re-keyed data. A code gets typed wrong, an authorization number is left off, or a diagnosis never makes it across. Each one costs a resubmission and weeks of waiting.

Pabau, the practice management platform we build, takes out the re-keying. Its claims management software pre-fills the claim from the patient record, with the CPT and ICD-10 codes already attached. Built-in CPT and ICD-10 lookup libraries help staff find the right code.

The claim won’t send until required fields, such as the authorization number, are complete. US claims go to payers through the Claim.MD clearinghouse, with real-time eligibility checks, ERA posting and claim tracking. That leaves your team free to work the appeals that deserve the effort.

Simplify radiology billing from order to payment

Pabau pre-fills 70487 claims from the patient record, checks required fields before sending, and submits through Claim.MD with real-time eligibility checks. Your billing team spends less time re-keying data.

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Conclusion

CPT code 70487 rewards practices that settle the contrast question before the scan, not after the denial. Agree the protocol with the ordering physician, make the report prove what was given, and match the modifier to where the scan happened.

The trade-off is a few extra checks at intake in exchange for fewer appeals later. An authorization confirmed at booking is one less denial to chase in six weeks.

Book a demo to see how Pabau pre-fills and validates imaging claims, so your 70487 submissions go out complete.

Continue your research

Want a full breakdown of how to manage imaging claim denials? Denial management in healthcare walks through CARC-based denial categorization and appeal prioritization.

Preparing a clean 837P file for your radiology claims? 837 file billing guide explains the EDI format, required fields, and the submission errors that cause rejections.

Need to understand how the clearinghouse processes your 70487 claims? Claim.MD clearinghouse explained covers how electronic claims are routed, validated, and acknowledged before reaching the payer.

Need a standard way to request imaging approval? Medical prior authorization form gives your team a template for the clinical details payers ask for.

Want your imaging claims to hold up in an audit? Medical billing compliance covers the rules and safeguards that keep coded claims defensible.

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