CT of the Head

LCD Information Document Information Source LCD ID N/A LCD ID L34417 Original ICD-9 LCD ID Not Applicable LCD Title CT of the Head Proposed LCD in Comment Period N/A Source Proposed LCD DL34417 Opens in a new window Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 08/17/2023 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date 04/27/2017 Notice Period End Date 06/11/2017 CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. Current Dental Terminology © 2025 American Dental Association. All rights reserved. Copyright © 2026, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at ub04@aha.org or 312‐422‐3366. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates. Issue Issue Description This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity. Issue - Explanation of Change Between Proposed LCD and Final LCD CMS National Coverage Policy Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.42 CFR §410.32(a)(b) Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: ConditionsCMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §220.1 Computed Tomography (CT) Coverage Indications, Limitations, and/or Medical Necessity A cranial computerized tomographic (CT) scan is a very useful and informative neurodiagnostic tool. Scanning of the head in successive layers by a narrow beam of x-rays enables the transmission of x-ray photons in each layer to be measured. A computer is used to process the accumulated x-ray photon data and constructs a graphic image of a tomographic slice. Normal intracranial structures and a wide variety of intracranial disorders may be demonstrated. A cranial CT scan may be ordered without contrast, with injection of standard roentgenographic contrast material or without contrast material, followed by contrast material and further sections. Contrast administration is not without risk to the patient and for some conditions adds little or no benefit to the examination.Cranial CT scans are determined to be reasonable and necessary and are a covered service when the patient has clinical evidence of an intracranial disorder or an established intracranial disorder or disease. The general indications for use of contrast CT scanning are:1. To assess perfusion (e.g., cerebrovascular accident [CVA])2. To characterize a specific lesion3. To detect defects in blood/brain barrier (e.g., infarcts, tumors, infection, vasculitis)4. To detect neovascularity (tumors); or5. For staging of known lung cancer, breast cancer, and lymphomas which are likely to metastasize early to the brain Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A

A cranial computerized tomographic (CT) scan is a very useful and informative neurodiagnostic tool. Scanning of the head in successive layers by a narrow beam of x-rays enables the transmission of x-ray photons in each layer to be measured. A computer is used to process the accumulated x-ray photon data and constructs a graphic image of a tomographic slice. Normal intracranial structures and a wide variety of intracranial disorders may be demonstrated. A cranial CT scan may be ordered without contrast, with injection of standard roentgenographic contrast material or without contrast material, followed by contrast material and further sections. Contrast administration is not without risk to the patient and for some conditions adds little or no benefit to the examination. Cranial CT scans are determined to be reasonable and necessary and are a covered service when the patient has clinical evidence of an intracranial disorder or an established intracranial disorder or disease. The general indications for use of contrast CT scanning are: 1. To assess perfusion (e.g., cerebrovascular accident [CVA]) 2. To characterize a specific lesion 3. To detect defects in blood/brain barrier (e.g., infarcts, tumors, infection, vasculitis) 4. To detect neovascularity (tumors); or 5. For staging of known lung cancer, breast cancer, and lymphomas which are likely to metastasize early to the brain