Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP)

Coverage for computed tomography cerebral perfusion analysis (CPT 0042T) requires the study be performed in a certified stroke center and, effective 2021-12-12, the CPT 0042T claim must include the KX modifier attesting performance in a certified stroke center. If performed in the emergency department (POS 23), the ER must be part of that certified stroke center to qualify; all claims must include ICD-10-CM diagnosis codes. Medical records must document medical necessity, include a signed formal written report with interpreting provider identification, test reason, images and reconstruction data, and be available to Medicare on request.

"Computed tomography cerebral perfusion analysis (CPT 0042T) is covered when the CTP study is performed in a certified stroke center."

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