| Procedure Code | Description | Setting | Coverage |
|---|---|---|---|
| 72192 | COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL | outpatient | covered |
| 72193 | COMPUTED TOMOGRAPHY, PELVIS; WITH CONTRAST MATERIAL(S) | outpatient | covered |
| 72194 | COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS | outpatient | covered |
| 74150 | COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL | outpatient | covered |
| 74160 | COMPUTED TOMOGRAPHY, ABDOMEN; WITH CONTRAST MATERIAL(S) | outpatient | covered |
| 74170 | COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS | outpatient | covered |
| 74176 | COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL | outpatient | covered |
| 74177 | COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S) | outpatient | covered |
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