For Dates of Service Before January 1, 2024

Radiology Services Procedure Codes
Chest 71045–71048
Spine and pelvis 72170, 72190, 72200, 72202
Abdomen 74018–74021
Gynecological and obstetrical 74710
Abdomen and peritoneum 76705
Pelvis 76805, 76815, 76856
Extremities 76885–76886
Ultrasonic guidance procedures 76946