CT head without contrast (70450) + CT sinuses without contrast (70486)
When both head and sinus CTs are performed in the same session, NCCI may bundle them depending on clinical indication.
Why this pair bundles
Overlap in anatomical coverage — if both ordered for the same indication, bundling applies.
Modifier-bypass policy
Modifier indicator: 1 — modifier 59 / XE / XP / XS / XU permitted when supporting documentation is on file.
Modifier 59 or XS (separate structure) when distinct clinical indications support each study.
Documentation requirements
- Two distinct clinical indications
- Separate orders documenting different anatomical targets
- Different radiology reports
Common clinical scenarios
- Head trauma with separate sinus complaint
- Stroke workup PLUS sinusitis evaluation
Frequently asked questions
Why does CMS bundle 70450 and 70486?
Overlap in anatomical coverage — if both ordered for the same indication, bundling applies.
When can I use modifier 59 (or X{EPSU}) to bypass?
Modifier 59 or XS (separate structure) when distinct clinical indications support each study.
What documentation supports separate billing?
Two distinct clinical indications; Separate orders documenting different anatomical targets; Different radiology reports.
When does this conflict typically arise?
Head trauma with separate sinus complaint; Stroke workup PLUS sinusitis evaluation.
Sources
Catch NCCI 70450/70486 conflicts before submission
ApprovalHelp auto-flags NCCI bundling conflicts on the claim line before you submit. Modifier-bypass eligibility checked against current quarterly NCCI tables. no setup fee.
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