The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Computed Tomography Cerebral Perfusion Analysis (CTP) L38769.
Documentation Requirements:
The patient’s medical record should include but is not limited to:
• The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
• Relevant medical history
• Results of pertinent tests/procedures
• Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)
• Performance of the study in a stroke center
Coding Information:
Effective 1/1/26 CPT code 0042T was replaced with CPT codes 70472 & 70473 for Computed Tomography Cerebral Perfusion Analysis (CTP). Claims with date of service prior to 1/1/26 should still use 0042T.
CPT code 70472 is for CTP performed at the same time as CT or cerebral computed tomography angiography (CCTA) and must be listed separately in addition to code for primary procedure.
Append computed tomography cerebral perfusion analysis identified with CPT 0042T or 70472 with the KX modifier to attest the CTP analysis was performed in a certified stroke center.
CPT code 70473 is CTP performed without concurrent CT or CT angiography. The LCD requires that CTPs performed on eligible patients based on CCTA results, therefore this code must be associated with the CCTA to be eligible for payment and documentation of previous CCTA is required. Append computed tomography cerebral perfusion analysis identified with CPT 70473 with the KX modifier to attest the CTP analysis was performed in a certified stroke center. This includes cases in which the patient was transferred to a certified stroke center after having the CCTA done and therefore only requiring the analysis to be performed.
If the service is provided in the emergency room (POS 23) the ER must be part of the certified stroke center to qualify for coverage.
The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must be submitted with ICD-10-CM codes that reflect the condition of the patient and indicate the reason(s) for which the service was performed. Claims submitted without ICD-10-CM codes will be returned.
The documentation of the study requires a formal written report, with clear identifying demographics, the name of the interpreting provider, the reason for the tests, an interpretive report and copies of images. The computerized image reconstruction data should also be maintained.
Documentation must be available to Medicare upon request.
