CPT 72146Radiology

Mri chest spine w/o dye

CPT code 72146 is used when a patient receives an MRI scan of the thoracic spine (mid-back region) without using contrast dye. This imaging helps doctors diagnose conditions like herniated discs, spinal fractures, tumors, or infections in the middle portion of the spine.

Showing rates for

National Average

Base Medicare rate

$187.93

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.48

PE RVU (NF)

4.24

MP RVU

0.09

Total RVU

5.81

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Verify contrast usage documentation before coding - ensure physician order and radiologist report explicitly state 'without contrast' to justify 72146 rather than 72147 (with contrast) or 72157 (without and with contrast)
Impact: Prevents denials and recoupment; incorrect contrast coding is the #1 audit trigger for spine MRIs and can result in $100+ payment adjustments per claim
Bill global code only when your facility owns both equipment and employs the interpreting radiologist; split using 26/TC modifiers when components are separate
Impact: Ensures correct payment allocation; billing global when only providing TC can result in overpayment and recoupment of approximately $37-56 (20-30% of $187.93)
Document medical necessity with specific ICD-10 codes linking to thoracic spine pathology - avoid lumbar-only diagnoses when billing thoracic MRI
Impact: Reduces denial rate by 40-60%; many payers auto-deny 72146 when paired with lumbar-specific diagnosis codes like M51.16 or M54.5
Check for Local Coverage Determinations (LCDs) requiring prior authorization - many Medicare contractors and commercial payers require pre-approval for spine MRIs
Impact: Prevents denials averaging $187.93 per claim; appeals success rate for lack of authorization is typically under 15%
Ensure minimum 72-hour interval when billing repeat MRI with modifier 76 or different anatomical region on same day to avoid bundling edits
Impact: Protects additional $187.93 payment when legitimate repeat imaging is medically necessary; same-day repeats without proper modifier result in 95% denial rate
Verify National Correct Coding Initiative (NCCI) edits before billing 72146 with other spine imaging on same date - may require 59 modifier or separate sessions

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Frequently asked questions

What is the CPT code 72146 used for?

CPT code 72146 is used for magnetic resonance imaging (MRI) of the thoracic spine (mid-back region covering vertebrae T1 through T12) performed without contrast dye. It's ordered to diagnose conditions like herniated discs, spinal stenosis, fractures, infections, or tumors in the thoracic spine.

How much does Medicare pay for CPT code 72146 in 2025?

Medicare pays $187.93 for CPT code 72146 in 2025 based on the national average non-facility rate. This payment is the same for both facility and non-facility settings at $187.93, with a total RVU value of 5.81 using the 2025 conversion factor of 32.3465.

What is the difference between CPT 72146 and 72147?

CPT 72146 is an MRI of the thoracic spine without contrast dye, while CPT 72147 is an MRI of the thoracic spine with contrast material administered intravenously. The choice depends on clinical indication - contrast is typically used when evaluating infection, inflammation, tumors, or post-surgical changes where enhanced tissue differentiation is needed.

Does CPT 72146 require prior authorization?

Prior authorization requirements for CPT 72146 vary by payer and state. Most Medicare Advantage plans, many commercial insurers, and some state Medicaid programs require pre-authorization for thoracic spine MRIs. Providers should verify specific payer policies before scheduling to avoid denials. Additionally, PAMA appropriate use criteria requirements may apply.

What diagnosis codes are appropriate for billing CPT 72146?

Appropriate ICD-10 codes for CPT 72146 include thoracic-specific diagnoses such as M51.04 (thoracic intervertebral disc disorders with myelopathy), M51.14 (thoracic disc disorders with radiculopathy), M48.04-M48.05 (thoracic spinal stenosis), S22.0xxA (thoracic vertebral fracture), M46.24 (osteomyelitis of thoracic region), and C79.51 (secondary malignant neoplasm of bone). The diagnosis must specifically indicate thoracic spine involvement.

Can CPT 72146 and 72148 be billed together?

Yes, CPT 72146 (thoracic spine MRI) and 72148 (lumbar spine MRI) can be billed together when both anatomical regions are medically necessary and separately documented. However, modifier 59 may be required to bypass NCCI edits with some payers. Documentation must clearly support distinct medical necessity for imaging both regions, and some payers may require separate sessions or different dates of service.

What are the RVU values for CPT code 72146?

CPT code 72146 has 2025 RVU values of: Work RVU 1.48, non-facility PE RVU 4.24, facility PE RVU 4.24, and Malpractice RVU 0.09, totaling 5.81 RVUs. When multiplied by the 2025 conversion factor of 32.3465, this equals the Medicare payment rate of $187.93.