A two-view chest radiograph, usually a frontal and a lateral image, used to look at the lungs, heart size, and chest wall.
- Medicare
- $33.07
- Work RVU
- 0.21
- Global, days
- Region
- Other
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Number of views stated in the report
- Clinical reason beyond scheduled surgery, such as COPD, heart failure, or dyspnea
- Order signed by the treating provider
- Mechanism of injury for trauma films
- ABN on file when the test may not meet Medicare necessity
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
71046 is the standard two-view chest x-ray. In orthopedics it is most often part of the pre-op workup before a joint replacement or spine fusion, or part of a trauma evaluation after a fall or crash.
The pre-op use is where denials happen. Medicare does not pay for screening tests done only because surgery is scheduled. The chest film is payable when the patient has a sign, symptom, or condition that makes it necessary: known heart or lung disease, a cough, shortness of breath, or an abnormal exam. Code that condition, not just the joint diagnosis. Z01.811 (pre-procedural respiratory exam) can go on the claim, but put the clinical condition with it. On its own it reads as screening.
For trauma, the chest x-ray documents rib fractures, pneumothorax, or clavicle injuries. If a dedicated rib series is also done, that is a different code. A one-view chest film is 71045, and three views is 71047, so count the views on the report.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.21) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (0.99) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.21 |
| Practice expense RVU | 0.76 |
| Malpractice RVU | 0.02 |
| Total RVU | 0.99 |
| Medicare national rate | $33.07 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $33.07 |
HOPD (APC 5521) Hospital outpatient department | $88.91 |
Common denial reasons
The recurring reasons claims for CPT 71046 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Pre-op screening with no sign, symptom, or chronic condition coded
- View count on the report does not match the code
- Joint diagnosis only, with nothing tying the film to the chest
- Duplicate film within a short window from another facility
- Missing ABN when billing the patient after a Medicare denial
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Does Medicare pay for a pre-op chest x-ray?
02What is the difference between 71045, 71046, and 71047?
03Should I get an ABN for a pre-op chest x-ray?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe pulls the patient's heart and lung history and current symptoms into the pre-op note, so a chest film ordered before surgery has a real indication on the chart.
See how Mira captures CPT 71046 documentation