Radiology Benefits
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    Radiology Applicable Codes

    Arms and Shoulders

    Tariff Code Description
    61100 X-Ray Of The Left Clavicle
    61105 X-Ray Of The Right Clavicle
    61110 X-Ray Of The Left Scapula
    61115 X-Ray Of The Right Scapula
    61120 X-Ray Of The Left Acromio-Clavicular Joint
    61125 X-Ray Of The Right Acromio-Clavicular Joint
    61130 X-Ray Of The Left Shoulder
    61135 X-Ray Of The Right Shoulder
    62100 X-Ray Of The Left Humerus
    62105 X-Ray Of The Right Humerus
    63100 X-Ray Of The Left Elbow
    63105 X-Ray Of The Right Elbow
    64100 X-Ray Of The Left Forearm
    64105 X-Ray Of The Right Forearm

    Hand and Wrist

    Tariff Code Description
    65100 X-Ray Of The Left Hand
    61105 X-Ray Of The Right Hand
    65120 X-Ray Of A Finger
    65130 X-Ray Of The Left Wrist
    65135 X-Ray Of The Right Wrist
    65140 X-Ray Of The Left Scaphoid
    65145 X-Ray Of The Right Scaphoid

    Legs and Knees

    Tariff Code Description
    71100 X-Ray Of The Left Femur
    71105 X-Ray Of The Right Femur
    72100 X-Ray Of The Left Knee One Or Two Views
    72105 X-Ray Of The Right Knee One Or Two Views
    73100 X-Ray Of The Left Lower Leg
    73105 X-Ray Of The Right Lower Leg
    72150 X-Ray Both Knees Standing – Single View

    Foot and Ankle

    Tariff Code Description
    74145 X-Ray Of A Toe
    74100 X-Ray Of The Left Ankle
    74105 X-Ray Of The Right Ankle
    74120 X-Ray Of The Left Foot
    74125 X-Ray Of The Right Foot
    74130 X-Ray Of The Left Calcaneus
    74135 X-Ray Of The Right Calcaneus


    Tariff Code Description
    30100 X-Ray Of The Chest, Single View
    30110 X-Ray Of The Chest Two Views, PA & Lateral
    30150 X-Ray Of The Ribs
    30155 X-Ray Of The Chest And Ribs

    Pregnancy: 2 Per Pregnancy

    Tariff Code Description
    43250 Ultrasound Of The Pregnant Uterus, First Trimester


    Tariff Code Description
    51110 X-Ray Of The Cervical Spine, 1 Or 2 Views
    52100 X-Ray Of The Thoracic Spine,1 Or 2 Views
    53110 X-Ray Of The Lumbar Spine, 1 Or 2 Views


    Tariff Code Description
    40100 X-Ray Of The Abdomen
    40105 X-Ray Of The Abdomen Supine & Erect, Or Decubitus

    Pelvis and Hip

    Tariff Code Description
    55100 X-Ray Of The Pelvis
    56100 X-Ray Of The Left Hip
    56110 X-Ray Of The Right Hip
    56120 X-Ray Pelvis And Hips

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