Just wanted to share an update I learned today since I previously posted the CPT codes for CTA head and neck imaging.
As of January 1, 2026, the coding changed. Previously the combined study was typically billed using:
70496 = CTA head
70498 = CTA neck
There is now a combined CPT code:
70471 = CTA head and neck CTA performed together this code covers with and without contrast
Also, depending on what is being evaluated, some people may want to discuss with their physician whether a multi-phase contrast acquisition protocol is appropriate so both peak arterial flow and delayed venous outflow phases are captured, rather than arterial timing alone.
Mentioning it in case it helps anyone when discussing imaging orders, protocols, authorizations, or insurance approvals with their doctors.
Thank you so much for this information, @MGORNEAU. The suggestion of requesting a multi-phase contrast acquisition protocol is significant especially for those who are seeking a diagnosis for vES. Is that something new or just something that hasn’t been mentioned here before?
@Isaiah_40_31 It’s not really new, more that it often isn’t discussed much outside vascular or neurovascular imaging circles.
Standard CTA protocols are commonly optimized for arterial evaluation, so depending on the timing, venous structures may not always opacify as well. In situations where venous compression or outflow obstruction is part of the question like suspected vascular Eagle Syndrome/internal jugular vein compression some physicians may request protocols that include delayed venous phase imaging or combined CTA/CTV timing to better visualize both arterial inflow and venous drainage.
I actually ended up researching this while preparing for my own upcoming CTA/CTV request related to the arcuate foramen (ponticulus posticus/Kimmerle anomaly) involving the vertebral artery, and it was interesting how much protocol timing can influence what structures are adequately visualized.
The exact protocol can vary a lot by institution and radiologist, so it’s something worth discussing with the ordering physician and imaging center ahead of time if venous structures are an important part of the clinical question.
So I am getting a CTA study with perfusion of the head and neck done on Thursday, in a stroke center at a hospital. Would the perfusion part of it line up with what you’re talking about?
I ran that question through Chatgpt and this was the response:
Not necessarily, although there can be some overlap depending on the protocol being used.
CT perfusion is typically designed to evaluate blood flow dynamics within brain tissue itself (things like cerebral blood flow, transit times, ischemia/stroke evaluation), whereas the delayed venous phase imaging I was referring to is more about improving visualization of venous drainage pathways and possible compression or outflow obstruction in structures like the internal jugular veins.
That said, stroke-center protocols are often more advanced and may include multiphase acquisitions or broader vascular timing windows than a standard outpatient CTA, so it’s possible the study could capture useful venous information as well. It really depends on the exact protocol the neuroradiology team is using.
Probably worth asking the ordering physician or imaging department whether the exam includes delayed venous phase imaging / CTV timing in addition to the arterial CTA and perfusion sequences, especially if venous compression or vascular Eagle Syndrome is part of the diagnostic question.
Thanks! After sending the questions last night, I also searched using Grok. What you’re saying lines up with what Grok said too. So I might just relax about it, especially since we’re doing an angiogram-venogram catheter study next Tuesday with Dr. Fargen. Don’t you think that study should pick up anything the CTA with perfusion misses?
Thanks for that info @MGORNEAU ! We see more members with venous compression, so do always encourage members to ensure the venous phase is covered too, I didn’t know that the CTA is the more common protocol though…