CPT Code 71046: Chest X-Ray, Two Views

Quick Answers

What does CPT 71046 cover?
CPT 71046 is a two-view chest X-ray, typically a PA (frontal) and lateral projection, used to evaluate the lungs, heart, mediastinum, and chest wall. It’s chosen based on exact view count and is never billed alongside 71045 or 71047 for the same study.

How does the modifier 26/TC split work?
Use no modifier when the same provider owns the equipment and interprets the study (global). Use modifier 26 for the professional component when a physician interprets but doesn’t own the equipment, and modifier TC for the technical component when the facility owns the equipment but doesn’t interpret. Getting this split wrong is one of the most common and costly errors on this code.

Is 71046 covered for screening or asymptomatic patients?
Generally, no. Coverage requires a diagnostic indication such as cough, shortness of breath, chest pain, or suspected pneumonia. Routine screening or pre-employment films are usually non-covered without a documented risk factor.

What CPT Code 71046 Covers

The AMA descriptor is:

71046, Radiologic examination, chest; 2 views.

The defining element is the view count: exactly two views, typically PA and lateral. If only one view is taken, it is a different code. If three or more are taken, it is a different code again. The two-view study gives a fuller read than a single frontal film, because findings hidden behind the heart or in the posterior chest often show only on the lateral.

The Chest X-Ray Family: Code by View Count

Chest X-ray codes are differentiated almost entirely by the number of views performed. Pick one code based on the total views, and never stack them:

These codes are mutually exclusive for the same encounter. Billing 71045 and 71046 together for one study is unbundling and will be denied or recouped. The single most effective control is requiring the radiology report to state the views explicitly, for example “PA and lateral views,” which removes the guesswork that drives view-count audits.

The Component Split That Decides Who Gets Paid

This is the concept generic definition pages skip, and it is the heart of imaging billing. Every diagnostic imaging service has two parts:

• The technical component (modifier TC): the equipment, supplies, technologist, and facility cost of acquiring the image.
• The professional component (modifier 26): the physician’s supervision, interpretation, and report.

How you report 71046 depends on who did what:

• Global (no modifier): the same provider owns the equipment and interprets the image, for example a radiologist in a private imaging center who performs and reads the study. Bill 71046 with no modifier.
• Professional only (71046-26): the physician interprets the study but does not own the equipment, for example an outside radiologist reading a film taken at a hospital.
• Technical only (71046-TC): the facility owns the equipment and provides the staff but does not interpret, for example a freestanding center that sends the read out.

The payment roughly splits 60 percent to the technical component and 40 percent to the professional component, which reflects the cost of equipment and staffing versus the interpretation. Getting this split wrong, billing global when you only earned one component, or appending the wrong modifier, is one of the most common and costly chest X-ray errors.

How Hospitals, Imaging Centers, and Radiologists Bill It Differently

Place of service changes the mechanics. A hospital bills the facility (technical) side on its institutional claim, and when the radiologist is hospital-employed, the professional component is captured through the hospital rather than billed separately. A freestanding imaging center that owns the equipment but sends the read to an outside physician bills 71046-TC, while that outside physician bills 71046-26. A physician who both owns the equipment and reads the study bills the global code. Mapping each study to the correct scenario before it goes out is what keeps the revenue clean.

Medical Necessity: The Diagnosis Has to Support the Study

The code describes what was done, but the diagnosis is what gets it paid. Medicare and most payers cover a chest X-ray when it is ordered for a diagnostic reason supported by signs, symptoms, or history, such as cough, shortness of breath, chest pain, fever with respiratory symptoms, or suspected pneumonia. Routine screening of an asymptomatic patient, including most pre-employment films, is generally not covered without a documented risk factor. Medicare’s chest X-ray coverage runs through a local coverage determination with specific ICD-10 logic, so the ordering diagnosis has to match a covered indication, the same medical-necessity principle that governs every imaging study, from a symptom code like abdominal pain, R10.30, through to advanced studies like CT of the abdomen and pelvis, CPT 74176. For appropriateness of the study itself, the American College of Radiology guidelines are the reference standard.

Common 71046 Billing Mistakes

• Billing 71046 with 71045 or 71047 for the same study. Choose one code by view count.
• Billing the global code when only the technical or only the professional component was performed. Use TC or 26.
• Appending 26 or TC incorrectly for the place of service, especially in the hospital setting.
• Reporting a two-view code when the documentation supports only a single view, or the reverse.
• Billing a chest X-ray for asymptomatic screening without a covered indication.
• Failing to document the specific views, which triggers view-count denials.

Frequently Asked Questions

Note: CPT codes and descriptors are maintained by the American Medical Association and are provided here for reference. Coverage, component, and modifier rules vary by payer and by Medicare contractor, so verify against current policies and local coverage determinations before billing.