Source-backed quick answer
CPT 71046 chest x-ray 2 views code
CPT 71046 is used for a chest radiologic examination with two views. Before billing, confirm the physician order, two-view documentation, clinical indication, image interpretation, report, component billing, modifier rules, and payer medical necessity edits.
AMA maintains CPT, while CMS and payer rules affect radiology documentation, modifier use, and reimbursement review.
- Chest x-ray two-view service
- Order and report validation
- Component billing review
- Modifier and medical necessity check
Official sources
Understanding CPT 71046
CPT 71046 covers a radiologic examination of the chest with two views, typically posteroanterior (PA) and lateral projections. This is the standard chest X-ray code used across virtually every medical specialty, from primary care to pulmonology to emergency medicine. The two-view chest X-ray remains one of the most frequently ordered diagnostic imaging studies in the United States, with an estimated 75 million performed annually.
The chest X-ray code family includes 71045 (single view), 71046 (2 views), and 71048 (3 or more views). Selection depends on the number of radiographic views obtained, not the number of films or digital images. A standard PA and lateral chest X-ray is always coded as 71046 regardless of whether additional oblique or decubitus views would have been clinically useful but were not performed.
Technical and Professional Components
Like most diagnostic imaging codes, 71046 can be billed as a global code or split into technical and professional components. The global code (71046 without modifier) is used when the same entity provides both the X-ray equipment and technologist (technical) and the physician interpretation (professional). The technical component (71046-TC) covers equipment, supplies, and technologist services. The professional component (71046-26) covers the radiologist’s or other qualified physician’s interpretation and report.
In hospital settings, the facility bills the technical component and the interpreting radiologist bills the professional component. In physician offices that own X-ray equipment and have a qualified interpreting physician, the global code captures both components. Urgent care centers and emergency departments follow similar splitting rules based on their employment and contracting structures.
Non-radiologist physicians can bill the professional component (71046-26) for chest X-ray interpretation if they are qualified and produce a written report. However, some payers restrict professional component payment to board-certified radiologists. Practices should verify payer policies before non-radiologists bill for X-ray interpretation.
Documentation Standards
A complete chest X-ray interpretation must include the patient’s name and date of birth, the date of the examination, the clinical indication (why the study was ordered), a description of the views obtained, a systematic evaluation of the radiographic findings, comparison with prior studies when available, and a clinical impression or diagnosis. The report must be signed by the interpreting physician.
The systematic evaluation should address the cardiac silhouette (size and contour), mediastinum, hila and pulmonary vasculature, lung fields (both lungs, all zones), pleural spaces, bony thorax (ribs, spine, clavicles), and soft tissues. Even when the study is normal, the report should mention each anatomic region to demonstrate completeness of the interpretation.
Common diagnostic indications that support medical necessity include cough (R05.9), chest pain (R07.9), dyspnea (R06.00), fever (R50.9), pneumonia (J18.9), COPD exacerbation (J44.1), pre-operative clearance (Z01.818), and follow-up of known pulmonary abnormality. Using specific ICD-10 codes rather than generic symptom codes improves claim acceptance rates.
Reimbursement Rates
Medicare reimbursement for the global 71046 in 2026 averages $28-$35, with the technical component at approximately $15-$20 and the professional component at $12-$16. These rates have declined over the past decade as CMS has reduced imaging reimbursement through practice expense recalculations and the Multiple Procedure Payment Reduction (MPPR) policy.
Commercial payer rates for 71046 range from $40-$90 for the global code, with significant variation by market. Negotiating X-ray reimbursement rates is important for high-volume practices, though individual X-ray rates often receive less attention than higher-cost imaging studies. Practices should review their overall imaging reimbursement as a package during payer negotiations.
The cost of providing in-office chest X-ray services includes equipment (digital X-ray systems range from $50,000-$150,000), radiation safety equipment and monitoring, annual physics surveys, technologist salary and benefits, and supplies. Break-even analysis typically shows that practices need 15-25 X-rays per week to justify the equipment investment, depending on payer mix and reimbursement rates.
Common Billing Errors
The most frequent billing error with 71046 is selecting the wrong code based on the number of views. Billing 71046 when only a single PA view was obtained (which should be 71045) or billing 71046 when three views were taken (which should be 71048) results in either overpayment or underpayment. Verify the number of views from the technologist’s documentation or the DICOM image count before coding.
Another common error involves duplicate billing when a chest X-ray is interpreted by both the ordering physician and a radiologist. Only one professional component interpretation is payable per study per date. If an emergency physician performs a preliminary interpretation and a radiologist provides the official reading, only the radiologist’s interpretation is typically billable as the professional component.
Portable chest X-rays performed at the bedside in hospitals should not be coded as 71046 unless two actual views were obtained. Portable studies often capture only a single AP view, which should be coded as 71045. Billing 71046 for a single portable view is incorrect and will be denied or recouped upon audit.
Quality and Compliance
The Mammography Quality Standards Act (MQSA) does not apply to chest X-rays, but state radiation safety regulations and facility accreditation standards do. The American College of Radiology (ACR) offers voluntary accreditation for general radiography that demonstrates quality standards to payers and patients.
Quality metrics for chest X-ray programs include interpretation accuracy (measured through peer review or correlation with CT findings), report turnaround time, repeat rate (percentage of studies requiring additional views due to technical quality), and critical finding communication timeliness. Tracking these metrics supports quality improvement and provides documentation for payer credentialing and accreditation reviews.
Radiation dose monitoring is increasingly important for compliance and quality. Digital radiography systems should track and display dose metrics for each exposure. Practices should establish dose reference levels and investigate exposures that exceed established thresholds. While chest X-rays deliver relatively low radiation doses (approximately 0.1 mSv for a 2-view study), demonstrating dose awareness is part of responsible imaging practice.
Ordering patterns should also be monitored for appropriateness. Routine daily chest X-rays for hospitalized patients without specific clinical indications represent both unnecessary radiation exposure and wasteful spending. Evidence-based ordering protocols tied to clinical triggers improve quality and reduce costs while maintaining diagnostic accuracy.